Provider Demographics
NPI:1922204767
Name:STURDEVANT, MARY R (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:STURDEVANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1033 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-2604
Mailing Address - Country:US
Mailing Address - Phone:417-831-2327
Mailing Address - Fax:417-831-5122
Practice Address - Street 1:1033 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-2604
Practice Address - Country:US
Practice Address - Phone:417-831-2327
Practice Address - Fax:417-831-5122
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO151399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily