Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 108-26498 | PA |
NPI | 1083992853 |
---|---|
Provider Name | Mrs. Amy Marie Siegrist |
First Address | King Of Prussia, PA 19406-2217 |
Second Address | Wayne, PA 19087-1803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2011 |
Last Update Date | 09/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003140774 | INDEPENDENCE BLUE CROSS (01) | PA |
9929902 | AETNA (01) | PA |