Provider Demographics
NPI:1033731674
Name:ECK, SYDNEE ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:SYDNEE
Middle Name:ROSE
Last Name:ECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 VISTA LN STE 120
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4633
Mailing Address - Country:US
Mailing Address - Phone:775-451-3376
Mailing Address - Fax:775-490-0186
Practice Address - Street 1:1525 VISTA LN STE 120
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4633
Practice Address - Country:US
Practice Address - Phone:775-451-3376
Practice Address - Fax:775-490-0186
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02392363A00000X
NVPA2880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant