Healthcare Provider Details

I. General information

NPI: 1245445501
Provider Name (Legal Business Name): JOAN F SIEROCINSKI RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 HARKLE RD SUITE D
SANTA FE NM
87505-4753
US

IV. Provider business mailing address

PO BOX 26666 PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-922-3233
  • Fax: 505-922-3562
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR13824
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: