Provider Demographics
NPI:1356899389
Name:SIESEL, KAITLYN M
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:M
Last Name:SIESEL
Suffix:
Gender:F
Credentials:
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 1786
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-1786
Mailing Address - Country:US
Mailing Address - Phone:855-654-5262
Mailing Address - Fax:770-701-8675
Practice Address - Street 1:1801 16TH STREET
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631
Practice Address - Country:US
Practice Address - Phone:970-810-4121
Practice Address - Fax:770-701-6675
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111936367500000X
CA111936367500000X
COAPN.0993218-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered