Basic Information
Provider Information | |||||||||
NPI: | 1588973911 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SYKUTA | ||||||||
FirstName: | NATALIE | ||||||||
MiddleName: | ANNE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 636494 | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452636494 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4409893801 | ||||||||
FaxNumber: | 4409600264 | ||||||||
Practice Location | |||||||||
Address1: | 3500 KOLBE RD | ||||||||
Address2: |   | ||||||||
City: | LORAIN | ||||||||
State: | OH | ||||||||
PostalCode: | 440531632 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4409604900 | ||||||||
FaxNumber: | 4409341567 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/04/2010 | ||||||||
LastUpdateDate: | 06/22/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN285057 | OH | N |   | Nursing Service Providers | Registered Nurse |   | 363LA2200X | NP-11584 | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
ID | Type | State | Issuer | Description | 3108327 | 05 | OH |   | MEDICAID | 0207207 | 05 | OH |   | MEDICAID |