Active NPI
Edith Johanna Struik, PAC
- Physician Assistant
- Raleigh, NC
National Provider Identifier
1023108800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 102193
- Practice address
- 2605 Blue Ridge Rd
Suite 300
Raleigh, NC 27607 - Phone
- (919) 787-3448
- Fax
- (919) 232-0006
- NPI assigned
- Oct 13, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 102193 | NC | Primary |
Addresses
Primary practice location
2605 Blue Ridge Rd
Suite 300
Raleigh, NC 27607
Mailing address
5320 Goldenglow Way
Raleigh, NC 27606
Phone (919) 852-3633
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89013NA | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102193 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023108800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5320 GOLDENGLOW WAY",
"city": "RALEIGH",
"state": "NC",
"postal_code": "27606",
"telephone_number": "919-852-3633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2605 BLUE RIDGE RD",
"address_2": "SUITE 300",
"city": "RALEIGH",
"state": "NC",
"postal_code": "27607",
"telephone_number": "919-787-3448",
"fax_number": "919-232-0006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STRUIK",
"first_name": "EDITH",
"middle_name": "JOHANNA",
"name_prefix": "Ms.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "102193",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89013NA",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.