Individual
DR. JACKSON SITTENAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(785) 221-0744
Mailing address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(785) 221-0744
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
0101267940
VA
208D00000X
General Practice Physician
35.150161
OH
208D00000X
General Practice Physician
A193407
CA
208D00000X
General Practice Physician
E-17506
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/03/2018
Last updated
03/23/2024
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