Healthcare Provider Details

I. General information

NPI: 1457418576
Provider Name (Legal Business Name): JAYNE ELLEN STRATHE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 166 4TH STREET WEED ARMY HOSPITAL
FT IRWIN CA
92310-3802
US

IV. Provider business mailing address

1919 39TH ST
DES MOINES IA
50310-3802
US

V. Phone/Fax

Practice location:
  • Phone: 515-229-2604
  • Fax: 760-380-3291
Mailing address:
  • Phone: 515-229-2604
  • Fax: 760-380-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number097818
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: