Healthcare Provider Details

I. General information

NPI: 1053616300
Provider Name (Legal Business Name): RONALD STRACHAN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 AVENUE B
SCOTTSBLUFF NE
69361-4372
US

IV. Provider business mailing address

3011 AVENUE B
SCOTTSBLUFF NE
69361-4372
US

V. Phone/Fax

Practice location:
  • Phone: 308-632-2215
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number53226
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111217
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: