Provider Demographics
NPI:1003457649
Name:SIBERT, JULIE ANNE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:SIBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 DAYTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1526
Mailing Address - Country:US
Mailing Address - Phone:218-632-8485
Mailing Address - Fax:218-260-2727
Practice Address - Street 1:22 DAYTON AVE SE
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1526
Practice Address - Country:US
Practice Address - Phone:218-632-8485
Practice Address - Fax:218-260-2727
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR135747-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse