Provider Demographics
NPI:1275647513
Name:STURLIN,, CANDACE L (PA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:L
Last Name:STURLIN,
Suffix:
Gender:F
Credentials:PA
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 1998
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-1998
Mailing Address - Country:US
Mailing Address - Phone:405-842-4850
Mailing Address - Fax:405-848-2425
Practice Address - Street 1:7530 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4921
Practice Address - Country:US
Practice Address - Phone:405-787-8556
Practice Address - Fax:405-787-7424
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200005110AMedicaid
OK200005110AMedicaid
OK246731301Medicare PIN
OKP00474223Medicare PIN