Provider Demographics
NPI:1467935635
Name:SIEVERS, CHAD NATHANIEL
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:NATHANIEL
Last Name:SIEVERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:CUT BANK
Mailing Address - State:MT
Mailing Address - Zip Code:59427-3329
Mailing Address - Country:US
Mailing Address - Phone:406-873-2251
Mailing Address - Fax:406-873-3118
Practice Address - Street 1:1310 9TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2659
Practice Address - Country:US
Practice Address - Phone:406-799-0526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7233363A00000X
MT79074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant