MEDICARE: NICOLE SIYEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	0000248999	TN
2	367500000X	Certified Registered Nurse Anesthetist	APN0000031474	TN

General Provider Information

NPI Number	:	1497421143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SIYEM

Provider Business Mailing Address
First Line	:	3035 SAPGATE LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-3084
Country	:	US
Telephone Number	:	240-899-3479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 HAVENBROOK DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-2651
Country	:	US
Telephone Number	:	240-899-3479
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	06/08/2023

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Directions to “ NICOLE SIYEM ” Practice Location

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