Provider Demographics
NPI:1336388669
Name:STREIT, EDNA M (PA-C)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:M
Last Name:STREIT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EDNA
Other - Middle Name:
Other - Last Name:STREIT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:202 PROSPECT DR
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-1943
Mailing Address - Country:US
Mailing Address - Phone:406-345-3306
Mailing Address - Fax:
Practice Address - Street 1:202 PROSPECT DR
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1999
Practice Address - Country:US
Practice Address - Phone:406-345-3306
Practice Address - Fax:406-345-3324
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant