Provider Demographics
NPI:1366957060
Name:STRALEY, JACOB T (NP)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:T
Last Name:STRALEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4201 CAMPUS RIDGE DR STE 3000
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6135
Mailing Address - Country:US
Mailing Address - Phone:989-488-5450
Mailing Address - Fax:989-488-5455
Practice Address - Street 1:4201 CAMPUS RIDGE DR STE 3000
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6135
Practice Address - Country:US
Practice Address - Phone:989-488-5450
Practice Address - Fax:989-488-5455
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704291936363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner