Provider Demographics
NPI:1396802112
Name:STURDEVANT, REBECCA LOU (MSN, APRN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOU
Last Name:STURDEVANT
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LOU
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP
Mailing Address - Street 1:100 FLIGHT LINE LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-9069
Mailing Address - Country:US
Mailing Address - Phone:406-250-1250
Mailing Address - Fax:
Practice Address - Street 1:77 ANTOSKI RD
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:AK
Practice Address - Zip Code:99741
Practice Address - Country:US
Practice Address - Phone:907-656-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN26050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT562261Medicare UPIN