Provider Demographics
NPI:1720748981
Name:SEIBERT, LISA DIANN (APRN, CNM, RNC-OB)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANN
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:APRN, CNM, RNC-OB
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DIANN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 LONDONDERRY DR STE 204
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7921
Mailing Address - Country:US
Mailing Address - Phone:254-772-5454
Mailing Address - Fax:
Practice Address - Street 1:405 LONDONDERRY DR STE 204
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7921
Practice Address - Country:US
Practice Address - Phone:254-772-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057085367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife