Provider Demographics
NPI:1235537713
Name:SIKKINK, NICHOLAS THOMAS
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:THOMAS
Last Name:SIKKINK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 TAURUS CT SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-1744
Mailing Address - Country:US
Mailing Address - Phone:507-202-0954
Mailing Address - Fax:
Practice Address - Street 1:1839 TAURUS CT SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-1744
Practice Address - Country:US
Practice Address - Phone:507-202-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1067511-1-AFC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist