Provider Demographics
NPI:1437660404
Name:SIEGEL, CARLI RUTH (NP)
Entity Type:Individual
Prefix:MRS
First Name:CARLI
Middle Name:RUTH
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 HAVERSTON RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1441
Mailing Address - Country:US
Mailing Address - Phone:440-339-0297
Mailing Address - Fax:
Practice Address - Street 1:1168 HAVERSTON RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-1441
Practice Address - Country:US
Practice Address - Phone:440-339-0297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF08170738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily