Healthcare Provider Details

I. General information

NPI: 1154620029
Provider Name (Legal Business Name): MILDRED ANN SIERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 AGLER ROAD SUITE 2800
COLUMBUS OH
43219-3387
US

IV. Provider business mailing address

P.O. BOX 16370
COLUMBUS OH
43216-6370
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-1600
  • Fax: 614-645-1348
Mailing address:
  • Phone: 614-645-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN185051-COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: