Healthcare Provider Details

I. General information

NPI: 1083703771
Provider Name (Legal Business Name): MARY ELAINE SYKORA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELAINE PUSATERI RN

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N 2ND AVE
IRON RIVER MI
49935-1451
US

IV. Provider business mailing address

715 PYLE DR
KINGSFORD MI
49802-4456
US

V. Phone/Fax

Practice location:
  • Phone: 906-265-5126
  • Fax: 906-265-5878
Mailing address:
  • Phone: 906-774-0522
  • Fax: 906-774-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704235050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: