1396802112 NPI number — REBECCA LOU STURDEVANT MSN, APRN

Table of content: REBECCA LOU STURDEVANT MSN, APRN (NPI 1396802112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396802112 NPI number — REBECCA LOU STURDEVANT MSN, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STURDEVANT
Provider First Name:
REBECCA
Provider Middle Name:
LOU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHNEIDER
Provider Other First Name:
REBECCA
Provider Other Middle Name:
LOU
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396802112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 FLIGHT LINE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-9069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-250-1250
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 ANTOSKI RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALENA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-656-1366
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN26050 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com