Healthcare Provider Details

I. General information

NPI: 1871109777
Provider Name (Legal Business Name): SHERYL TIGCHELAAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 PIONEER DRIVE
KITCHENER ONTARIO
N2P2A3
CA

IV. Provider business mailing address

123 PIONEER DR
KITCHENER ONTARIO
N2P2A3
CA

V. Phone/Fax

Practice location:
  • Phone: 519-772-2322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016110
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: