Provider Demographics
NPI:1598286536
Name:SIBLEY, SONNIER FAYE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SONNIER
Middle Name:FAYE
Last Name:SIBLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SONNIER
Other - Middle Name:FAYE
Other - Last Name:VANDER PLOEG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 BANK ST # 162
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6518
Mailing Address - Country:US
Mailing Address - Phone:928-240-8279
Mailing Address - Fax:
Practice Address - Street 1:823 GATEWAY CENTER WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4541
Practice Address - Country:US
Practice Address - Phone:619-906-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR197687363A00000X
AZ6735363A00000X
CA56521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant