Provider Demographics
NPI:1376182642
Name:SARKOR, JAMES (LPN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SARKOR
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14250 43RD AVE N APT D
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3628
Mailing Address - Country:US
Mailing Address - Phone:862-596-4057
Mailing Address - Fax:
Practice Address - Street 1:14250 43RD AVE N APT D
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3628
Practice Address - Country:US
Practice Address - Phone:862-596-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN81173-6164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty