Provider Demographics
NPI:1700020542
Name:SEIBERT, TIFFANY MARIE
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:MARIE
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 HAVERSTRAW AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2241
Mailing Address - Country:US
Mailing Address - Phone:937-272-1774
Mailing Address - Fax:
Practice Address - Street 1:2726 HAVERSTRAW AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2241
Practice Address - Country:US
Practice Address - Phone:937-272-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 338563163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse