MEDICARE: MILDRED ANN SIERS CNP

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	363LF0000X	Family Nurse Practitioner	RN185051-COA1	OH

General Provider Information

NPI Number	:	1154620029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILDRED ANN SIERS CNP

Provider Business Mailing Address
First Line	:	P.O. BOX 16370
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43216-6370
Country	:	US
Telephone Number	:	614-645-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3334 AGLER ROAD
Second Line	:	SUITE 2800
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3387
Country	:	US
Telephone Number	:	614-645-1600
Fax Number	:	614-645-1348

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

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	05/23/2012

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