MEDICARE: EDITH SIELSCH C.R.N.P.

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	363L00000X	Nurse Practitioner	VP003979X	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1621582	OTHER	PA	GATEWAY MEDICARE ASSURED

General Provider Information

NPI Number	:	1922007228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH SIELSCH C.R.N.P.

Provider Business Mailing Address
First Line	:	2587 WILDON DR
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-5215
Country	:	US
Telephone Number	:	717-428-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2587 WILDON DR
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-5215
Country	:	US
Telephone Number	:	717-428-9696
Fax Number	:

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	12/01/2015

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