Provider Demographics
NPI:1437837879
Name:SIEGMUND, DOUGLAS MARTIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MARTIN
Last Name:SIEGMUND
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 N. COTTONWOOD ST. UNIT 18
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865
Mailing Address - Country:US
Mailing Address - Phone:714-342-8684
Mailing Address - Fax:
Practice Address - Street 1:2915 N. COTTONWOOD ST. UNIT 18
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865
Practice Address - Country:US
Practice Address - Phone:714-342-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily