Provider Demographics
NPI:1578688362
Name:SIEKIERKA, MARISA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:SIEKIERKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 N KEYSER AVE
Mailing Address - Street 2:MEDICAL ASSOCIATES OF NEPA
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508
Mailing Address - Country:US
Mailing Address - Phone:570-969-1904
Mailing Address - Fax:570-969-2916
Practice Address - Street 1:1789 N KEYSER AVE
Practice Address - Street 2:MEDICAL ASSOCIATES OF NEPA
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508
Practice Address - Country:US
Practice Address - Phone:570-969-1904
Practice Address - Fax:570-969-2916
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051641207R00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine