Provider Demographics
NPI:1245655109
Name:STRUBLE, NICHOLE (LPN)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:STRUBLE
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 1:7930 NITTANY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MILL HALL
Mailing Address - State:PA
Mailing Address - Zip Code:17751-8805
Mailing Address - Country:US
Mailing Address - Phone:570-726-4306
Mailing Address - Fax:570-726-4082
Practice Address - Street 1:7930 NITTANY VALLEY DR
Practice Address - Street 2:
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-8805
Practice Address - Country:US
Practice Address - Phone:570-726-4306
Practice Address - Fax:570-726-4082
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN296652164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse