Healthcare Provider Details

I. General information

NPI: 1932502325
Provider Name (Legal Business Name): ANDREW JOHN SIEVILA RN, PMHCNS-BC, APNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 S 102ND ST SUITE 200
WEST ALLIS WI
53227-2466
US

IV. Provider business mailing address

2448 S 102ND ST SUITE 200
WEST ALLIS WI
53227-2466
US

V. Phone/Fax

Practice location:
  • Phone: 414-539-3024
  • Fax:
Mailing address:
  • Phone: 414-539-3024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number171212-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5279-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number2012002217
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5279-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: