Provider Demographics
NPI:1497409585
Name:STRACKE, EKA CLARISSA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:EKA
Middle Name:CLARISSA
Last Name:STRACKE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 GOODWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-6015
Mailing Address - Country:US
Mailing Address - Phone:443-992-1754
Mailing Address - Fax:
Practice Address - Street 1:600 E BELVEDERE AVE STE B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3713
Practice Address - Country:US
Practice Address - Phone:410-427-5140
Practice Address - Fax:410-825-5819
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR214831363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics