Healthcare Provider Details

I. General information

NPI: 1326626854
Provider Name (Legal Business Name): NICOLLE MARIE SIEGART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 116TH AVE SE
RENTON WA
98058-5200
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 425-400-1899
  • Fax: 425-663-8000
Mailing address:
  • Phone: 425-277-1311
  • Fax: 425-277-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61566422
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: