Provider Demographics
NPI:1548346026
Name:SIEFKEN, CAROLE MARY (ARNP)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:MARY
Last Name:SIEFKEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:MARY
Other - Last Name:VANDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 MANSFIELD ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3588
Mailing Address - Country:US
Mailing Address - Phone:509-943-0990
Mailing Address - Fax:509-943-0040
Practice Address - Street 1:1305 MANSFIELD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3588
Practice Address - Country:US
Practice Address - Phone:509-943-0990
Practice Address - Fax:509-943-0040
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00046264163WP0808X
WAAP30003275363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB09270Medicare PIN