MEDICARE: MISS LYNELL JOY STRAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker
2	376J00000X	Homemaker		NV

General Provider Information

NPI Number	:	1336657568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LYNELL JOY STRAKER

Provider Business Mailing Address
First Line	:	1461 W BARTLETT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2225
Country	:	US
Telephone Number	:	702-406-8622
Fax Number	:

Provider Business Practice Location Address
First Line	:	6655 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3915
Country	:	US
Telephone Number	:	702-722-6200
Fax Number	:	702-722-6202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	01/23/2018

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