Individual
HEDY LYDIA SIEDARTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6232 MARKET ST, PHILADELPHIA, PA 19139-2922
(215) 383-0191
Mailing address
1800 S 13TH ST, PHILADELPHIA, PA 19148-2126
(267) 467-0409
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
SP026217
PA
363LA2200X
Adult Health Nurse Practitioner
SP026217
PA
363LG0600X
Gerontology Nurse Practitioner
SP026217
PA
363LP2300X
Primary Care Nurse Practitioner
Primary
SP026217
PA
Other
Enumeration date
08/31/2022
Last updated
09/01/2022
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