Provider Demographics
NPI:1528109410
Name:SIKORSKI, CAROL LOUISE (WHNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUISE
Last Name:SIKORSKI
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-3521
Mailing Address - Country:US
Mailing Address - Phone:574-234-0933
Mailing Address - Fax:574-283-0054
Practice Address - Street 1:1901 W WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-3521
Practice Address - Country:US
Practice Address - Phone:574-234-0933
Practice Address - Fax:574-283-0054
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001090C363LX0001X
IN71001090A363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71001090COtherSTATE NP LICENSE #
IN71001090COtherSTATE NP LICENSE #
IN200504000Medicare ID - Type Unspecified