Healthcare Provider Details

I. General information

NPI: 1811632904
Provider Name (Legal Business Name): CHRISTINA JEAN SIEMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EASTOWNE DR
CHAPEL HILL NC
27514-2286
US

IV. Provider business mailing address

101 MANNING DR RM 1017
CHAPEL HILL NC
27514-4220
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-4462
  • Fax: 919-843-9355
Mailing address:
  • Phone: 919-966-1216
  • Fax: 919-843-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberSIEM-VTY19E
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: