Provider Demographics
NPI:1356835797
Name:SIEBERE, DAFE BENEDICT (RN, BSN)
Entity Type:Individual
Prefix:MR
First Name:DAFE
Middle Name:BENEDICT
Last Name:SIEBERE
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 LAUREL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2606
Mailing Address - Country:US
Mailing Address - Phone:773-653-7744
Mailing Address - Fax:
Practice Address - Street 1:5402 LAUREL RIDGE DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2606
Practice Address - Country:US
Practice Address - Phone:773-653-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235141163W00000X, 163WD1100X, 163WI0500X, 163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN235141OtherREGISTERED PROFESSIONAL NURSE