Provider Demographics
NPI:1639267818
Name:SIELBECK-BOWEN, KATHRYN ANNE (PHD CRNP)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANNE
Last Name:SIELBECK-BOWEN
Suffix:
Gender:F
Credentials:PHD CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S ELMIRA ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-1114
Mailing Address - Country:US
Mailing Address - Phone:570-882-9481
Mailing Address - Fax:570-882-1341
Practice Address - Street 1:102 DESMOND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2002
Practice Address - Country:US
Practice Address - Phone:570-882-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN2994921163WP0200X
PAJP002048D363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner