Individual
BENJAMIN CLARK SICKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
301 HIGHWAY 65 S, MORA, MN 55051-1899
(320) 225-3335
(320) 225-3345
Mailing address
35463 PALISADE DR NE, CAMBRIDGE, MN 55008-8054
(763) 689-1008
(320) 225-3345
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
076734
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
076734
RN LICENSE
MN
Enumeration date
12/28/2006
Last updated
07/08/2007
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