Provider Demographics
NPI:1528593506
Name:PEMBER, SINIKKA
Entity Type:Individual
Prefix:
First Name:SINIKKA
Middle Name:
Last Name:PEMBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 PEAK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:CO
Mailing Address - Zip Code:80422-8933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:925 S SEMORAN BLVD
Practice Address - Street 2:#110A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5313
Practice Address - Country:US
Practice Address - Phone:888-830-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97259163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse