Provider Demographics
NPI:1831287259
Name:SICKLER, ELIZABETH M (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:SICKLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 MISSION WAY
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0160
Mailing Address - Country:US
Mailing Address - Phone:406-237-8989
Mailing Address - Fax:406-237-8990
Practice Address - Street 1:2223 MISSION WAY
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0160
Practice Address - Country:US
Practice Address - Phone:406-237-8989
Practice Address - Fax:406-237-8990
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0356363AM0700X
MT41199363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN475L5SIOtherBCBS OF MN
MN038153100Medicaid
ND27539OtherBCBS OF ND
MN038153100Medicaid
NDQ73604Medicare UPIN