Suzanne P Straub, ANP
Individual provider Active NPI Adult Health Nurse Practitioner · Eagle River, AK
NPI 1154467520 · NPPES record last updated Apr 9, 2008
Key facts
- NPI
- 1154467520
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 904 (AK)
- Practice address
- 11470 Business Blvd
Ste 100
Eagle River, AK 99577-7721 - Phone
- (907) 622-4325
- Fax
- (907) 622-4326
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2014 through Apr 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 904 | AK | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Acute Family Medicine Clinic Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 904 | AK | Yes |
Addresses
Primary practice location
11470 Business Blvd
Ste 100
Eagle River, AK 99577-7721
Mailing address
11470 Business Blvd
Ste 100
Eagle River, AK 99577-7721
Phone (907) 622-4325
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NPO904 | Medicaid | AK | |
| 25615 | Other | AK | RN LICENSE # |
| 907 | Other | AK | ANP ID # |
Other providers in Eagle River, AK
- Andrea Lynde Stearns
- Stefanie Summers, LTD
- Sarah Jean Stengle
- D'Yondre Xavier Stephen
- Jade Stovall
- Shelby Lynn Sturgis
- Terri Jean Sullivan
- Stefanie Lynn Summers
- Summit Dental Lab, Inc
- Summit Sunrise Counseling LLC
All providers in Eagle River, AK · Adult Health Nurse Practitioner in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.