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NPI Code Detail

MEDICARE: MR. RAYMOND EARL SISK

MEDICARE: MR. RAYMOND EARL SISK
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
1363LA2100XAcute Care Nurse Practitioner2011007020MO

General Provider Information

NPI Number : 1699067645
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RAYMOND EARL SISK
Provider Business Mailing Address
First Line : 1008 N MAIN ST
Second Line :
City : SIKESTON
State : MO
Zip : 63801-5044
Country : US
Telephone Number : 573-471-0200
Fax Number : 573-471-7559
Provider Business Practice Location Address
First Line : 102 HOSPITALITY DR
Second Line :
City : SIKESTON
State : MO
Zip : 63801-9382
Country : US
Telephone Number : 573-471-0200
Fax Number : 573-471-7559
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2011
Last Update Date : 03/10/2022

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Directions to “ MR. RAYMOND EARL SISK ” Practice Location

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