Provider Demographics
NPI:1548982317
Name:STRAKA, ROSE ELICH (RN, PHN)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ELICH
Last Name:STRAKA
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 SANDPIPER DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-7144
Mailing Address - Country:US
Mailing Address - Phone:775-233-4468
Mailing Address - Fax:530-923-2235
Practice Address - Street 1:1633 SANDPIPER DR
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-7144
Practice Address - Country:US
Practice Address - Phone:775-233-4468
Practice Address - Fax:530-923-2235
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255450163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA255450OtherREGISTERED NURSE
CA4725OtherDIRECTOR OF STAFF DEVELOPMENT
CA25169OtherPUBLIC HEALTH NURSE