Provider Demographics
NPI:1972855997
Name:STURDIVANT, JULIA A (RN)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:A
Last Name:STURDIVANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 HYDE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-2436
Mailing Address - Country:US
Mailing Address - Phone:716-278-5826
Mailing Address - Fax:716-278-5829
Practice Address - Street 1:910 HYDE PARK BOULEVARD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-278-5826
Practice Address - Fax:716-278-5829
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332875163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool