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General NPI Number Information
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NPI Number | 1760558605
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Entity Type | Individual
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Provider Name | JACALYN SIEMER CRNFA
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Gender | Female
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 520 N 3RD AVENUE
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City | SANDPOINT
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State | ID
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Zip | 83864
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Country | US
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Telephone | 208-263-1441
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Fax |
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Provider Business Mailing Address
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Address Line | 192 SUNRISE CIRCLE
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City | SAGLE
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State | ID
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Zip | 83860
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Country | US
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Telephone | 208-263-6752
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Fax |
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | N-21782
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License Number State | ID
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