Provider Demographics
NPI:1639216344
Name:SIAU, RODNEY KENNETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:KENNETH
Last Name:SIAU
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:PO BOX 71763
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-1763
Mailing Address - Country:US
Mailing Address - Phone:229-995-4832
Mailing Address - Fax:229-435-2857
Practice Address - Street 1:803 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2313
Practice Address - Country:US
Practice Address - Phone:229-435-0832
Practice Address - Fax:229-435-2857
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN100140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBDWFMedicare ID - Type Unspecified
GAP28091Medicare UPIN