Provider Demographics
NPI:1912795030
Name:MAHAN-DEITTE, SIENNA JOSEPHINE (PA-C)
Entity type:Individual
Prefix:
First Name:SIENNA
Middle Name:JOSEPHINE
Last Name:MAHAN-DEITTE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 DENVER AVE SE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-4514
Mailing Address - Country:US
Mailing Address - Phone:507-829-5080
Mailing Address - Fax:
Practice Address - Street 1:173 DENVER AVE SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-4514
Practice Address - Country:US
Practice Address - Phone:507-829-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15296363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant