Provider Demographics
NPI:1336657568
Name:STRAKER, LYNELL JOY
Entity Type:Individual
Prefix:MISS
First Name:LYNELL
Middle Name:JOY
Last Name:STRAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 W BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2225
Mailing Address - Country:US
Mailing Address - Phone:702-406-8622
Mailing Address - Fax:
Practice Address - Street 1:6655 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3915
Practice Address - Country:US
Practice Address - Phone:702-722-6200
Practice Address - Fax:702-722-6202
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
NV376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker