Provider Demographics
NPI:1093074650
Name:STURGEON FAMILY NURSE PRACTITIONER HEALTH CARE,PLC
Entity Type:Organization
Organization Name:STURGEON FAMILY NURSE PRACTITIONER HEALTH CARE,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:918-207-0970
Mailing Address - Street 1:18 PLAZA SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4751
Mailing Address - Country:US
Mailing Address - Phone:918-207-0970
Mailing Address - Fax:918-207-0971
Practice Address - Street 1:18 PLAZA SOUTH ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4751
Practice Address - Country:US
Practice Address - Phone:918-207-0970
Practice Address - Fax:918-207-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty