Provider Demographics
NPI:1568414191
Name:SIEFF, ANDREW B (APN, BC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:B
Last Name:SIEFF
Suffix:
Gender:M
Credentials:APN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11183 BLACK OAK ADDITION
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-0787
Mailing Address - Country:US
Mailing Address - Phone:479-871-2005
Mailing Address - Fax:479-582-1085
Practice Address - Street 1:111 E DAVIDSON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-3413
Practice Address - Country:US
Practice Address - Phone:479-871-2005
Practice Address - Fax:479-582-1085
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS01096364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKS80891Medicare UPIN