Provider Demographics
NPI:1235269358
Name:SICKELS, ANITA J (NP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:J
Last Name:SICKELS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 S CASCADE AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1604
Mailing Address - Country:US
Mailing Address - Phone:765-289-5006
Mailing Address - Fax:765-213-4953
Practice Address - Street 1:2610 TENDERFOOT HILL ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3981
Practice Address - Country:US
Practice Address - Phone:719-538-5718
Practice Address - Fax:719-226-8669
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMS0619277363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000273496OtherBCBS
IN000000273496OtherBCBS
INP48517Medicare UPIN