Provider Demographics
NPI:1275252827
Name:SIEBER, KYLE ERIC (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ERIC
Last Name:SIEBER
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8104 BOULDER CT
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5246
Mailing Address - Country:US
Mailing Address - Phone:847-312-5458
Mailing Address - Fax:
Practice Address - Street 1:8104 BOULDER CT
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5246
Practice Address - Country:US
Practice Address - Phone:847-312-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty