Provider Demographics
NPI:1336195924
Name:STRUBLE, TONYA L (CNP)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:L
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:L
Other - Last Name:MAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:300 S BYRON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325-9741
Mailing Address - Country:US
Mailing Address - Phone:605-234-6551
Mailing Address - Fax:605-234-7260
Practice Address - Street 1:300 S BYRON BLVD
Practice Address - Street 2:
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325-9741
Practice Address - Country:US
Practice Address - Phone:605-234-6551
Practice Address - Fax:605-234-7260
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000353363L00000X
SDR031583363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P68903Medicare UPIN
SDS100355Medicare PIN