Healthcare Provider Details

I. General information

NPI: 1356899389
Provider Name (Legal Business Name): MRS. KAITLYN M SIESEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 16TH STREET
GREELEY CO
80631
US

IV. Provider business mailing address

PO BOX 1786
FORT COLLINS CO
80522-1786
US

V. Phone/Fax

Practice location:
  • Phone: 970-810-4121
  • Fax: 770-701-6675
Mailing address:
  • Phone: 855-654-5262
  • Fax: 770-701-8675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number111936
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number111936
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0993218-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: