MEDICARE: RODNEY KENNETH SIAU FNP-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	363LF0000X	Family Nurse Practitioner	RN100140	GA

General Provider Information

NPI Number	:	1639216344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODNEY KENNETH SIAU FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 71763
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31708-1763
Country	:	US
Telephone Number	:	229-995-4832
Fax Number	:	229-435-2857

Provider Business Practice Location Address
First Line	:	803 N JACKSON ST
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-2313
Country	:	US
Telephone Number	:	229-435-0832
Fax Number	:	229-435-2857

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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