MEDICARE: NICOLE MARIE SICHTING WHNP CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	09000262A	IN

General Provider Information

NPI Number	:	1467830646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE SICHTING WHNP CNM

Provider Business Mailing Address
First Line	:	PO BOX 775383
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-5351
Country	:	US
Telephone Number	:	812-376-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 NORTHPARK DR STE A
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-2292
Country	:	US
Telephone Number	:	812-376-3311
Fax Number	:	812-376-4125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2015
Last Update Date	:	09/09/2024

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