Healthcare Provider Details

I. General information

NPI: 1902121965
Provider Name (Legal Business Name): PATRICIA ELIZABETH STRIETER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 28TH ST
PORT HURON MI
48060-6931
US

IV. Provider business mailing address

1036 BELLE RIVER WOODS BLVD
EAST CHINA MI
48054-4778
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-9396
  • Fax:
Mailing address:
  • Phone: 810-765-7904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704218674
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: