Provider Demographics
NPI:1972774560
Name:SIEMECK, ROXANNE JENNIFER (APRN, CNS-BC, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:JENNIFER
Last Name:SIEMECK
Suffix:
Gender:F
Credentials:APRN, CNS-BC, FNP-BC
Other - Prefix:
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Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:6TH FLOOR OUTPATIENT PAVILION
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-9132
Practice Address - Fax:708-520-1871
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209007019364SA2200X
IL209-007019364S00000X
IL209013887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209013887OtherFAMILY NURSE PRACTITIONER