Provider Demographics
NPI:1972125565
Name:STRACHAN, IDELL ANNETTE (RN)
Entity Type:Individual
Prefix:MS
First Name:IDELL
Middle Name:ANNETTE
Last Name:STRACHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 SEQUOIA LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-5544
Mailing Address - Country:US
Mailing Address - Phone:678-642-3788
Mailing Address - Fax:
Practice Address - Street 1:6150 SEQUOIA LN
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-5544
Practice Address - Country:US
Practice Address - Phone:678-620-9121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN206374163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse