Individual
MICHELLE RENEE STURDIVANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
616 SW 6TH ST, MOORE, OK 73160-2511
(405) 595-6969
Mailing address
616 SW 6TH ST, MOORE, OK 73160-2511
(405) 595-6969
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R0100094
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200791020A
—
OK
01
—
R0100094
LICENSE
OK
Enumeration date
10/29/2016
Last updated
12/26/2024
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