Provider Demographics
NPI:1588164040
Name:STRANDBERG, ERICA ANN (DO)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:STRANDBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:ANN
Other - Last Name:BEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8195 HIGHWAY 789
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2942
Mailing Address - Country:US
Mailing Address - Phone:307-206-1005
Mailing Address - Fax:
Practice Address - Street 1:8195 HIGHWAY 789
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2942
Practice Address - Country:US
Practice Address - Phone:307-206-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL6839207Q00000X
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty