Provider Demographics
NPI:1710416300
Name:STRUBLE, STEPHANIE INA MARY (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:INA MARY
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:INA MARY
Other - Last Name:WALIZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1951 PINE HALL ROAD SUITE 225
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5106
Mailing Address - Country:US
Mailing Address - Phone:814-237-0001
Mailing Address - Fax:814-237-0116
Practice Address - Street 1:1951 PINE HALL ROAD SUITE 225
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5106
Practice Address - Country:US
Practice Address - Phone:814-237-0001
Practice Address - Fax:814-237-0001
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant