Provider Demographics
NPI:1710976329
Name:STRAUB, CHERYL (CRNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:STRAUB
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 VINE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-2035
Mailing Address - Country:US
Mailing Address - Phone:814-834-7431
Mailing Address - Fax:
Practice Address - Street 1:ERPG KEYSTONE MEDICAL ASSOCIATES
Practice Address - Street 2:136 STATE STREET
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-1626
Practice Address - Country:US
Practice Address - Phone:814-781-6758
Practice Address - Fax:814-834-1038
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004206B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS59506Medicare UPIN
PA011508Medicare ID - Type Unspecified