Healthcare Provider Details

I. General information

NPI: 1073861050
Provider Name (Legal Business Name): BLAIRE A SIEFKEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2012
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL LN
CALAIS ME
04619-1329
US

IV. Provider business mailing address

24 HOSPITAL LN
CALAIS ME
04619-1329
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-7521
  • Fax: 207-454-3616
Mailing address:
  • Phone: 207-454-7521
  • Fax: 207-454-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP151071
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: