Provider Demographics
NPI:1285817502
Name:SIVAK, AMBER NIKOLE (LPN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NIKOLE
Last Name:SIVAK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:NIKOLE
Other - Last Name:SIVAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:336 LOCUST FORGE LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7603
Mailing Address - Country:US
Mailing Address - Phone:513-435-3713
Mailing Address - Fax:
Practice Address - Street 1:336 LOCUST FORGE LN
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-7603
Practice Address - Country:US
Practice Address - Phone:513-435-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.126299IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse