Provider Demographics
NPI:1457514614
Name:STURGEON, NATALIE LANETTE (PAC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:LANETTE
Last Name:STURGEON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-3321
Mailing Address - Country:US
Mailing Address - Phone:731-855-3510
Mailing Address - Fax:731-855-1387
Practice Address - Street 1:500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-3321
Practice Address - Country:US
Practice Address - Phone:731-855-3510
Practice Address - Fax:731-855-1387
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1614363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant