Healthcare Provider Details

I. General information

NPI: 1861854499
Provider Name (Legal Business Name): MS. ANGELA DENISE STURDIVANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 1ST ST NE
CENTER POINT AL
35215-5603
US

IV. Provider business mailing address

PO BOX 9715
BIRMINGHAM AL
35220-0715
US

V. Phone/Fax

Practice location:
  • Phone: 205-401-7312
  • Fax:
Mailing address:
  • Phone: 205-401-7312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number124274
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: