MEDICARE: KIRSTEN SIWY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	0010-11992	NC
2	363AM0700X	Medical Physician Assistant	MA063462	PA

General Provider Information

NPI Number	:	1003559832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN SIWY PA-C

Provider Business Mailing Address
First Line	:	314 EAGLE DR
Second Line	:
City	:	EMMAUS
State	:	PA
Zip	:	18049-1926
Country	:	US
Telephone Number	:	610-393-3253
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 OLDE WATERFORD WAY STE 1B
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-4168
Country	:	US
Telephone Number	:	910-679-3212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	04/19/2022

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