1649552142 NPI number — MRS. ELISABETH ANN SIEBEL GIVEN R.N.

Table of content: MRS. ELISABETH ANN SIEBEL GIVEN R.N. (NPI 1649552142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649552142 NPI number — MRS. ELISABETH ANN SIEBEL GIVEN R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEBEL GIVEN
Provider First Name:
ELISABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIEBEL
Provider Other First Name:
ELISABETH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649552142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 WILDWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RONKONKOMA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11779-4849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-838-9961
Provider Business Mailing Address Fax Number:
631-648-4957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 WILDWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RONKONKOMA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11779-4849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-838-9961
Provider Business Practice Location Address Fax Number:
631-648-4957
Provider Enumeration Date:
09/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  578268-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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