Healthcare Provider Details

I. General information

NPI: 1578078598
Provider Name (Legal Business Name): LINDSEY SIEFKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST STE 3100B
DAYTON OH
45409-2722
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B3
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-4110
  • Fax:
Mailing address:
  • Phone: 937-991-3186
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.020994
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: