Provider Demographics
NPI:1073861050
Name:SIEFKEN, BLAIRE A (FNP)
Entity Type:Individual
Prefix:
First Name:BLAIRE
Middle Name:A
Last Name:SIEFKEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1329
Mailing Address - Country:US
Mailing Address - Phone:207-454-7521
Mailing Address - Fax:207-454-3616
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1329
Practice Address - Country:US
Practice Address - Phone:207-454-7521
Practice Address - Fax:207-454-3616
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP151071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD376751500Medicaid