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NPI Code Detail

MEDICARE: TARA MARIE STRUEBEL N.P.

MEDICARE: TARA MARIE STRUEBEL N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF339764-1NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1J400237042OTHERNYMEDICARE PTAN

General Provider Information

NPI Number : 1164804373
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA MARIE STRUEBEL N.P.
Provider Business Mailing Address
First Line : 3041 ORCHARD PARK RD
Second Line : D
City : ORCHARD PARK
State : NY
Zip : 14127-1208
Country : US
Telephone Number : 716-671-8393
Fax Number : 716-671-8398
Provider Business Practice Location Address
First Line : 3041 ORCHARD PARK RD
Second Line : D
City : ORCHARD PARK
State : NY
Zip : 14127-1208
Country : US
Telephone Number : 716-671-8393
Fax Number : 716-671-8398
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2015
Last Update Date : 09/16/2015

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