Healthcare Provider Details

I. General information

NPI: 1215570056
Provider Name (Legal Business Name): ILONA LAZDANE-SIKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 PIERCE DR
COLUMBUS OH
43223-2425
US

IV. Provider business mailing address

765 PIERCE DR
COLUMBUS OH
43223-2425
US

V. Phone/Fax

Practice location:
  • Phone: 614-223-1650
  • Fax: 888-679-9808
Mailing address:
  • Phone: 614-223-1650
  • Fax: 888-679-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number424912
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: