Provider Demographics
NPI:1770154742
Name:CICERO, SIERRA SUMMER (SUPPORT STAFF)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:SUMMER
Last Name:CICERO
Suffix:
Gender:F
Credentials:SUPPORT STAFF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 N D ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-2314
Mailing Address - Country:US
Mailing Address - Phone:918-426-1614
Mailing Address - Fax:
Practice Address - Street 1:1602 N D ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-2314
Practice Address - Country:US
Practice Address - Phone:918-426-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator