Provider Demographics
NPI:1912150673
Name:STRAUB, RENE ROCHELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:ROCHELLE
Last Name:STRAUB
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:ROCHELLE
Other - Last Name:URBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:EAST CIRCLE DR
Mailing Address - Street 2:OLIN HEALTH CENTER
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1037
Mailing Address - Country:US
Mailing Address - Phone:517-884-6546
Mailing Address - Fax:517-432-9460
Practice Address - Street 1:EAST CIRCLE DR
Practice Address - Street 2:OLIN HEALTH CENTER
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1037
Practice Address - Country:US
Practice Address - Phone:517-884-6546
Practice Address - Fax:517-432-9460
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704200966163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM61830019Medicare PIN