Provider Demographics
NPI:1760531842
Name:SIEKAS, LACEY L (ARNP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:L
Last Name:SIEKAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 OLIVE WAY MSC M4-PA
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006526363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9639352Medicaid
WA7632CAOtherBLUE SHIELD #
WAP00088317OtherRAILROAD MC#
WA0039573OtherLABOR AND INDUSTRIES #
WAUS7161430OtherAETNA SPECIALIST PIN
WA8852087Medicare PIN
WAAB40229Medicare PIN
WAUS7161430OtherAETNA SPECIALIST PIN
WA7632CAOtherBLUE SHIELD #