Provider Demographics
NPI:1821239864
Name:STREB, CHARLENE ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:ANN
Last Name:STREB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BIG TREE ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14487-9609
Mailing Address - Country:US
Mailing Address - Phone:585-346-7309
Mailing Address - Fax:
Practice Address - Street 1:30 BIG TREE ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:NY
Practice Address - Zip Code:14487-9609
Practice Address - Country:US
Practice Address - Phone:585-346-7309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174097-1372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion