Healthcare Provider Details

I. General information

NPI: 1306648167
Provider Name (Legal Business Name): CONNER STURGEON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N EAGLESON AVE
BLOOMINGTON IN
47405-3190
US

IV. Provider business mailing address

600 N EAGLESON AVE
BLOOMINGTON IN
47405-3190
US

V. Phone/Fax

Practice location:
  • Phone: 812-855-5711
  • Fax:
Mailing address:
  • Phone: 812-855-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011866A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: