Provider Demographics
NPI:1336577709
Name:STRUBLE, ZELLENE (CPM, LMT)
Entity type:Individual
Prefix:
First Name:ZELLENE
Middle Name:
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:CPM, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:OR
Mailing Address - Zip Code:97544-0554
Mailing Address - Country:US
Mailing Address - Phone:240-285-4223
Mailing Address - Fax:
Practice Address - Street 1:421 DAVIDSON RD
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:OR
Practice Address - Zip Code:97544-9604
Practice Address - Country:US
Practice Address - Phone:240-285-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2004-1417225700000X
OR111058374J00000X
VA0129000089176B00000X
ORDEM-LD-10241653176B00000X
OR26626225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula