Provider Demographics
NPI:1720357304
Name:SICKAFOOSE, NANCY (RN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SICKAFOOSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:SICKAFOOSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:612 MCKINNES BR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4080
Mailing Address - Country:US
Mailing Address - Phone:706-799-4719
Mailing Address - Fax:
Practice Address - Street 1:612 MCKINNES BR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4080
Practice Address - Country:US
Practice Address - Phone:706-799-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA155675163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine