Basic Information
| Provider Information | |||||||||
| NPI: | 1629309166 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STURGEON | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | MAUREEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1324 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370643784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157941542 | ||||||||
| FaxNumber: | 6155951214 | ||||||||
| Practice Location | |||||||||
| Address1: | 1324 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370643784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157941542 | ||||||||
| FaxNumber: | 6155951214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2010 | ||||||||
| LastUpdateDate: | 01/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | 0000112905 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.