Healthcare Provider Details

I. General information

NPI: 1043998628
Provider Name (Legal Business Name): CAROLINE CHUNG STRECKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 S HIGHWAY 95
MOHAVE VALLEY AZ
86440-8519
US

IV. Provider business mailing address

5556 S INTEGRITY LN
FORT MOHAVE AZ
86426-8861
US

V. Phone/Fax

Practice location:
  • Phone: 928-768-7113
  • Fax:
Mailing address:
  • Phone: 928-514-3722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number294574
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number876943
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: