Provider Demographics
NPI:1891973244
Name:SEIBERT, JOLYN M (RD)
Entity Type:Individual
Prefix:
First Name:JOLYN
Middle Name:M
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2472 W LADLE RAPIDS ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4771
Mailing Address - Country:US
Mailing Address - Phone:208-343-3883
Mailing Address - Fax:208-493-3078
Practice Address - Street 1:2472 W. LADLE RAPIDS STREET
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-4771
Practice Address - Country:US
Practice Address - Phone:208-343-3883
Practice Address - Fax:208-493-3087
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD043133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered