Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 26NJ00405500 | NJ |
NPI | 1477964393 |
---|---|
Provider Name | Amy Sisk |
First Address | Summit, NJ 07901-3533 |
Second Address | Summit, NJ 07901-3533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 13/05/2014 |