Provider Demographics
NPI:1013444629
Name:STARKEY, NICHOLAS (CCP, LP)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:STARKEY
Suffix:
Gender:M
Credentials:CCP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E FIELDSTONE CIR APT 5
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-7704
Mailing Address - Country:US
Mailing Address - Phone:414-801-1362
Mailing Address - Fax:
Practice Address - Street 1:9200 W. WISCONSIN AVENUE
Practice Address - Street 2:MCW - DIVISION OF CARDIOTHORACIC SURGERY
Practice Address - City:WAUWAUTOSA
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-955-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI175-18242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist