MEDICARE: SYDNEY KAY STURDEVANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	120476	SD

General Provider Information

NPI Number	:	1811492341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY KAY STURDEVANT

Provider Business Mailing Address
First Line	:	2021 S MAIN AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-2933
Country	:	US
Telephone Number	:	605-359-1539
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 S CLIFF AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1007
Country	:	US
Telephone Number	:	605-322-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	06/01/2026

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