Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN-517973-L | PA |
NPI | 1023064169 |
---|---|
Provider Name | Mrs. Jennifer M Siegle |
First Address | Glen Mills, PA 19342-2601 |
Second Address | Philadelphia, PA 19104-4306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 23/07/2007 |