=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316214042
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRISHA M STRAYER NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2011
-----------------------------------------------------
Last Update Date | 01/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9000 N MAIN ST STE G-35
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45415-1182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-836-4361
-----------------------------------------------------
Fax | 937-836-1140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3170 KETTERING BLVD BLDG B3
-----------------------------------------------------
City | MORAINE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45439-1924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-991-3188
-----------------------------------------------------
Fax | 937-223-9811
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 71007205A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.021642
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------