Healthcare Provider Details

I. General information

NPI: 1134947344
Provider Name (Legal Business Name): CARMEN SYKORA RN CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21950 ALABAMA HIGHWAY 181
FAIRHOPE AL
36532
US

IV. Provider business mailing address

9351 BRIGHTON AVE
ELBERTA AL
36530-5044
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-6300
  • Fax:
Mailing address:
  • Phone: 251-979-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number1-153600
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: