Provider Demographics
NPI:1649552142
Name:SIEBEL GIVEN, ELISABETH ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:ANN
Last Name:SIEBEL GIVEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ELISABETH
Other - Middle Name:ANN
Other - Last Name:SIEBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:226 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4849
Mailing Address - Country:US
Mailing Address - Phone:631-838-9961
Mailing Address - Fax:631-648-4957
Practice Address - Street 1:226 WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4849
Practice Address - Country:US
Practice Address - Phone:631-838-9961
Practice Address - Fax:631-648-4957
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY578268-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse