Healthcare Provider Details

I. General information

NPI: 1316774714
Provider Name (Legal Business Name): SIERRA MAASKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIERRA ROOD

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

2247 W THOMAS ST UNIT 1R
CHICAGO IL
60622-3515
US

V. Phone/Fax

Practice location:
  • Phone: 312-947-1400
  • Fax:
Mailing address:
  • Phone: 815-238-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number041.516829
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: