Healthcare Provider Details

I. General information

NPI: 1396465936
Provider Name (Legal Business Name): JOSPHAT W SIKWATA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 KELSEY KNLS
SANTA ROSA CA
95403-0132
US

IV. Provider business mailing address

3637 KELSEY KNLS
SANTA ROSA CA
95403-0132
US

V. Phone/Fax

Practice location:
  • Phone: 269-352-2201
  • Fax:
Mailing address:
  • Phone: 269-352-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number766769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: