Provider Demographics
NPI:1922262203
Name:SIEGEL, HEATHER LEE (ARNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEE
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEE
Other - Last Name:WANZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1812 S J ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4964
Mailing Address - Country:US
Mailing Address - Phone:253-207-4890
Mailing Address - Fax:
Practice Address - Street 1:1812 S J ST
Practice Address - Street 2:SUITE 120
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4964
Practice Address - Country:US
Practice Address - Phone:253-207-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60023480163W00000X
WAAP60023685363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8948472OtherCRIME VICTIM
WA0240198OtherL&I
WA0273066OtherSTATE L&I
WA9658261Medicaid
WAG8898014Medicare PIN
WA0240198OtherL&I