Provider Demographics
NPI:1326521097
Name:SIFUENTES, ELIZABETH NICOLE (HM IDC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:SIFUENTES
Suffix:
Gender:F
Credentials:HM IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS MICHIGAN- COMMANDER SUB GROUP NINE
Mailing Address - Street 2:2150 THRESHER AVE
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98315-2150
Mailing Address - Country:US
Mailing Address - Phone:360-396-6821
Mailing Address - Fax:
Practice Address - Street 1:USS MICHIGAN- COMMANDER SUB GROUP NINE
Practice Address - Street 2:2150 THRESHER AVE
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98315-2150
Practice Address - Country:US
Practice Address - Phone:360-396-6821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman