Provider Demographics
NPI:1518580620
Name:SIRA, CRISTINA GOLAJER (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:GOLAJER
Last Name:SIRA
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1S072 LUTHER AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1S072 LUTHER AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4164
Practice Address - Country:US
Practice Address - Phone:630-247-8877
Practice Address - Fax:630-618-3894
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty