Provider Demographics
NPI:1124360664
Name:SICKLER, JANESSA S (DO)
Entity Type:Individual
Prefix:DR
First Name:JANESSA
Middle Name:S
Last Name:SICKLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JANESSA
Other - Middle Name:S
Other - Last Name:PILLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:180 FORD RD
Mailing Address - Street 2:
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845-2009
Mailing Address - Country:US
Mailing Address - Phone:541-575-0404
Mailing Address - Fax:541-575-1124
Practice Address - Street 1:180 FORD RD
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-2009
Practice Address - Country:US
Practice Address - Phone:541-575-0404
Practice Address - Fax:541-575-1124
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORDO171718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500659933Medicaid