Provider Demographics
NPI:1871010918
Name:DARICEK, SABRINA KAY
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:KAY
Last Name:DARICEK
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 1:513 N 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2913
Mailing Address - Country:US
Mailing Address - Phone:406-304-7044
Mailing Address - Fax:
Practice Address - Street 1:1715 S RESERVE ST STE B
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4708
Practice Address - Country:US
Practice Address - Phone:406-304-3015
Practice Address - Fax:406-304-3096
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2017MSSGEN00123374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide