Provider Demographics
NPI:1851981997
Name:SILLICK, JOHANNA LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:LYNN
Last Name:SILLICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOLYNN
Other - Middle Name:
Other - Last Name:SILLICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3765 ARROYO SORRENTO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2606
Mailing Address - Country:US
Mailing Address - Phone:858-794-7612
Mailing Address - Fax:
Practice Address - Street 1:3765 ARROYO SORRENTO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2606
Practice Address - Country:US
Practice Address - Phone:858-794-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427827163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse