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General NPI Number Information
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NPI Number | 1881350866
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Entity Type | Individual
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Provider Name | NICOLE SIEWERT
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Gender | Female
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Dates
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Enumeration Date | 11/13/2021
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 211 BIEDE AVE
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City | DEFIANCE
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State | OH
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Zip | 43512-2497
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Country | US
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Telephone | 419-782-8856
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Fax |
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Provider Business Mailing Address
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Address Line | 740 DEERWOOD DR
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City | DEFIANCE
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State | OH
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Zip | 43512-8126
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Country | US
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Telephone | 419-436-6971
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 416866
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License Number State | OH
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