Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 209.010200 | IL |
NPI | 1023416856 |
---|---|
Provider Name | Shannon Sikkila |
First Address | Chicago, IL 60625-3543 |
Second Address | Chicago, IL 60625-3645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2014 |
Last Update Date | 12/01/2016 |