Provider Demographics
NPI:1700919842
Name:STURGIS, MARY JEAN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JEAN
Last Name:STURGIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4949
Mailing Address - Country:US
Mailing Address - Phone:803-774-5279
Mailing Address - Fax:803-774-5226
Practice Address - Street 1:129 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4949
Practice Address - Country:US
Practice Address - Phone:803-774-5279
Practice Address - Fax:803-774-5226
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC604363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0551Medicaid
SC7477Medicare PIN
SCNP0551Medicaid