Basic Information
| Provider Information | |||||||||
| NPI: | 1619599883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIEDENBURG | ||||||||
| FirstName: | DENA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5115 F ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681172807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022065949 | ||||||||
| FaxNumber: | 4023971404 | ||||||||
| Practice Location | |||||||||
| Address1: | 5115 F ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681172807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022065949 | ||||||||
| FaxNumber: | 4023971404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2020 | ||||||||
| LastUpdateDate: | 05/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0807X | 58846 | NE | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent |
No ID Information.