Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 95012863 | CA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95012863 | CA |
NPI | 1528688298 |
---|---|
Provider Name | Ms. Deborah Ohui Siameh |
First Address | Anaheim, CA 92803-5090 |
Second Address | Anaheim, CA 92801-2806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2020 |
Last Update Date | 22/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
836688 | CA BOARD OF REGISTERED NURSING (01) | CA |
95012863 | CA BOARD OF REGISTERED NURSING (01) | CA |
MS5595535 | DEA (01) | CA |