Individual
KATHLEEN SIEBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
603 MEDICAL PARKWAY, ENTERPRISE, OR 97828-1168
(541) 426-4502
(541) 426-6403
Mailing address
603 MEDICAL PARKWAY, ENTERPRISE, OR 97828-1168
(541) 426-4502
(541) 426-6403
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
78040158
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267989
—
OR
01
—
5966003
BCBS
OR
01
—
J054904
PACIFIC SOURCE
OR
Enumeration date
08/23/2005
Last updated
10/11/2013
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