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General NPI Number Information
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NPI Number | 1104809268
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Entity Type | Individual
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Provider Name | JENNIFER SUZANNE SIEGEL FNP
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Gender | Female
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 9615 FRANKFORD AVENUE 2ND FLOOR
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City | LUBBOCK
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State | TX
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Zip | 79424
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Country | US
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Telephone | 806-761-0267
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Fax | 806-761-0268
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Provider Business Mailing Address
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Address Line | 5219 CITY BANK PKWY STE 35
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City | LUBBOCK
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State | TX
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Zip | 79407-3545
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Country | US
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Telephone | 806-761-0333
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Fax | 806-782-0097
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP110517
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License Number State | TX
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