Provider Demographics
NPI:1457949828
Name:STRACKBEIN, ANNA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:STRACKBEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 UNION RD STE A
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2201
Mailing Address - Country:US
Mailing Address - Phone:919-636-0047
Mailing Address - Fax:704-866-4437
Practice Address - Street 1:1530 UNION RD STE A
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2201
Practice Address - Country:US
Practice Address - Phone:704-867-6188
Practice Address - Fax:704-866-4437
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11031363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty