Provider Demographics
NPI:1700414547
Name:SIEVERS, DEDE L
Entity Type:Individual
Prefix:MRS
First Name:DEDE
Middle Name:L
Last Name:SIEVERS
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:PO BOX 982
Mailing Address - Street 2:
Mailing Address - City:MILLS
Mailing Address - State:WY
Mailing Address - Zip Code:82644-0982
Mailing Address - Country:US
Mailing Address - Phone:307-259-6331
Mailing Address - Fax:
Practice Address - Street 1:2723 W RENAUNA AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-9691
Practice Address - Country:US
Practice Address - Phone:307-259-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health