Provider Demographics
NPI:1851776496
Name:STRADER, GOLDIE DIANE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:GOLDIE
Middle Name:DIANE
Last Name:STRADER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:351 N SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4656
Mailing Address - Country:US
Mailing Address - Phone:956-247-7000
Mailing Address - Fax:956-361-0854
Practice Address - Street 1:2050 N EXPRESSWAY STE A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-1735
Practice Address - Country:US
Practice Address - Phone:956-621-2883
Practice Address - Fax:956-550-8955
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1851776496OtherNPI