Healthcare Provider Details

I. General information

NPI: 1881486728
Provider Name (Legal Business Name): SIANNA CONGDON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIANNA RUSSELL

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DUKE MEDICINE CIR
DURHAM NC
27710-1000
US

IV. Provider business mailing address

6104 YATES MILL POND RD
RALEIGH NC
27606-9622
US

V. Phone/Fax

Practice location:
  • Phone: 469-509-3402
  • Fax:
Mailing address:
  • Phone: 469-509-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number360216
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number973
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: