Healthcare Provider Details

I. General information

NPI: 1457446429
Provider Name (Legal Business Name): CARRIE R CICHOCKI SIEGWARTH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE R CICHOCKI CNP

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # P57
CLEVELAND OH
44195-5612
US

IV. Provider business mailing address

PO BOX 74953
CLEVELAND OH
44194-1036
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-0102
  • Fax: 216-636-1863
Mailing address:
  • Phone: 216-671-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN290702/PNS00030
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN40515/NPP37250
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN25645
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberNS-10529
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP-10530
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: