Provider Demographics
NPI:1780889881
Name:ANDERSEN, SYBILLE STILLGER (CPM, LM)
Entity type:Individual
Prefix:
First Name:SYBILLE
Middle Name:STILLGER
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-1942
Mailing Address - Country:US
Mailing Address - Phone:508-325-2953
Mailing Address - Fax:
Practice Address - Street 1:133 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-1942
Practice Address - Country:US
Practice Address - Phone:508-325-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1048176B00000X
VT1070000027176B00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1023561Medicaid