MEDICARE: SIEDA BARROW FNP

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	SP015976	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265634042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIEDA BARROW FNP

Provider Business Mailing Address
First Line	:	414 ROGER CHAFFEE SQ
Second Line	:
City	:	BEAR
State	:	DE
Zip	:	19701-6842
Country	:	US
Telephone Number	:	267-975-6765
Fax Number	:

Provider Business Practice Location Address
First Line	:	4098 EDGMONT AVE
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-2211
Country	:	US
Telephone Number	:	855-925-4733
Fax Number	:

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	04/13/2016

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