Provider Demographics
NPI:1194575829
Name:STRUBLE, CARLA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S DRYDEN ST
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-1313
Mailing Address - Country:US
Mailing Address - Phone:198-942-6596
Mailing Address - Fax:
Practice Address - Street 1:3361 E GARFIELD RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:MI
Practice Address - Zip Code:49421-9583
Practice Address - Country:US
Practice Address - Phone:989-426-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide