Individual
JESSICA LYNN SICKAFUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1044 BELMONT AVE, YOUNGSTOWN, OH 44504-1006
(330) 480-3658
(330) 286-5396
Mailing address
4135 BOARDMAN CANFIELD RD STE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN401845
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
129059
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE PTAN
OH
05
—
PENDING
—
OH
Enumeration date
01/07/2020
Last updated
01/07/2020
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