Provider Demographics
NPI:1811429525
Name:STRYKER, MYRA (LPN)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:STRYKER
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 1:3350 W GALBRAITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-3969
Mailing Address - Country:US
Mailing Address - Phone:513-367-4444
Mailing Address - Fax:513-367-4449
Practice Address - Street 1:3350 W GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-3969
Practice Address - Country:US
Practice Address - Phone:513-367-4444
Practice Address - Fax:513-367-4449
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.167955101YA0400X
OH080921164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)