MEDICARE: CAROL LOUISE SIKORSKI WHNP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	71001090C	IN
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	71001090A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71001090C	OTHER	IN	STATE NP LICENSE #

General Provider Information

NPI Number	:	1528109410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL LOUISE SIKORSKI WHNP

Provider Business Mailing Address
First Line	:	1901 W WESTERN AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46619-3521
Country	:	US
Telephone Number	:	574-234-0933
Fax Number	:	574-283-0054

Provider Business Practice Location Address
First Line	:	1901 W WESTERN AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46619-3521
Country	:	US
Telephone Number	:	574-234-0933
Fax Number	:	574-283-0054

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	03/07/2023

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