Provider Demographics
NPI:1376237891
Name:SIEGEL, AMANDA BETH (BSN, RN, CDCES)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:BSN, RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 DODSWORTH LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2443
Mailing Address - Country:US
Mailing Address - Phone:440-552-8596
Mailing Address - Fax:
Practice Address - Street 1:5820 DODSWORTH LN
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2443
Practice Address - Country:US
Practice Address - Phone:440-552-8596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH32300266163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator