Provider Demographics
NPI:1841888757
Name:STURGILL, LEWIS
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:
Last Name:STURGILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BROOKLYN ST
Mailing Address - Street 2:
Mailing Address - City:GLEN WHITE
Mailing Address - State:WV
Mailing Address - Zip Code:25849-4518
Mailing Address - Country:US
Mailing Address - Phone:681-427-1708
Mailing Address - Fax:
Practice Address - Street 1:200 BROOKLYN ST
Practice Address - Street 2:
Practice Address - City:GLEN WHITE
Practice Address - State:WV
Practice Address - Zip Code:25849-4518
Practice Address - Country:US
Practice Address - Phone:681-427-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2022-08-24
Deactivation Date:2022-08-19
Deactivation Code:
Reactivation Date:2022-08-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant