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General NPI Number Information
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NPI Number | 1013666809
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Entity Type | Individual
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Provider Name | JUSTIN LYLE SICHULA MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2022
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 2211 NE 139TH ST
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City | VANCOUVER
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State | WA
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Zip | 98686-2742
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Country | US
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Telephone | 360-487-1168
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Fax | 503-413-7361
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Provider Business Mailing Address
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Address Line | 109 S PEARL ST APT 2
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City | ELLENSBURG
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State | WA
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Zip | 98926-4002
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Country | US
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Telephone | 509-856-4968
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD61587710
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License Number State | WA
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