Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN2286738 | MA |
NPI | 1033628698 |
---|---|
Provider Name | Mr. Christian Sikora |
First Address | Springfield, MA 01199-1619 |
Second Address | Springfield, MA 01199-1619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2017 |
Last Update Date | 11/12/2018 |