Healthcare Provider Details

I. General information

NPI: 1356053763
Provider Name (Legal Business Name): JACLYN ELIZABETH SIEGEL APRN, FNP-C, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 LILAC LN
LITTLETON NH
03561-4502
US

IV. Provider business mailing address

64 LILAC LN
LITTLETON NH
03561-4502
US

V. Phone/Fax

Practice location:
  • Phone: 802-274-0762
  • Fax:
Mailing address:
  • Phone: 802-274-0762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number026.0132666
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number084137-21
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number084137-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: