Provider Demographics
NPI:1386240596
Name:STRAHL, VICTORIA CHARLENE (HOMECARE AIDE)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CHARLENE
Last Name:STRAHL
Suffix:
Gender:F
Credentials:HOMECARE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10217 SILVER GRADE CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4235
Mailing Address - Country:US
Mailing Address - Phone:505-489-8773
Mailing Address - Fax:
Practice Address - Street 1:10217 SILVER GRADE CT NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4235
Practice Address - Country:US
Practice Address - Phone:505-489-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3124159Medicaid