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NPI Code Detail

MEDICARE: CRYSTAL J STURGIS PA C

MEDICARE: CRYSTAL J STURGIS PA C
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
1363A00000XPhysician Assistant1491WI

General Provider Information

NPI Number : 1912993247
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL J STURGIS PA C
Provider Business Mailing Address
First Line : 3 NEENAH CTR
Second Line :
City : NEENAH
State : WI
Zip : 54956-3070
Country : US
Telephone Number : 920-831-5050
Fax Number :
Provider Business Practice Location Address
First Line : 2400 E CAPITOL DR
Second Line :
City : APPLETON
State : WI
Zip : 54911-8728
Country : US
Telephone Number : 920-831-5050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 08/15/2023

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