Provider Demographics
NPI:1548696313
Name:STRALKA-LARSON, AMY (NP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STRALKA-LARSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 MILLPOND DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5731
Mailing Address - Country:US
Mailing Address - Phone:216-302-3070
Mailing Address - Fax:
Practice Address - Street 1:4199 MILLPOND DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44122-5731
Practice Address - Country:US
Practice Address - Phone:216-302-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.15098363LP0808X
OHCOA.15098-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092038Medicaid
OH0092038Medicaid