Healthcare Provider Details

I. General information

NPI: 1619599883
Provider Name (Legal Business Name): DENA SIEDENBURG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5522 ELBA WAY
MYRTLE BEACH SC
29579-8709
US

IV. Provider business mailing address

5522 ELBA WAY
MYRTLE BEACH SC
29579-8709
US

V. Phone/Fax

Practice location:
  • Phone: 402-206-5949
  • Fax: 402-397-1404
Mailing address:
  • Phone:
  • Fax: 402-397-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number58846
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: