Provider Demographics
NPI:1326700089
Name:STURGEON, SAMANTHA (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:STURGEON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 S STRAITS HWY
Mailing Address - Street 2:
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-5146
Mailing Address - Country:US
Mailing Address - Phone:231-238-0581
Mailing Address - Fax:231-238-0856
Practice Address - Street 1:3860 S STRAITS HWY
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-5146
Practice Address - Country:US
Practice Address - Phone:231-238-0581
Practice Address - Fax:231-238-0856
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4760363AM0700X
MI5601010819363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical