Provider Demographics
NPI:1730953738
Name:STURGEON, CASSIA CORINNE (CMII)
Entity type:Individual
Prefix:
First Name:CASSIA
Middle Name:CORINNE
Last Name:STURGEON
Suffix:
Gender:F
Credentials:CMII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 S LEWIS AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1077
Mailing Address - Country:US
Mailing Address - Phone:918-960-7852
Mailing Address - Fax:539-664-5738
Practice Address - Street 1:6216 S LEWIS AVE STE 180
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1077
Practice Address - Country:US
Practice Address - Phone:918-960-7852
Practice Address - Fax:539-664-5738
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK999999171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator