Provider Demographics
NPI:1841392313
Name:SIBLEY, GRETCHEN MICHELLE (DO)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:MICHELLE
Last Name:SIBLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MAYNE ST
Mailing Address - Street 2:
Mailing Address - City:GYPSUM
Mailing Address - State:CO
Mailing Address - Zip Code:81637-9756
Mailing Address - Country:US
Mailing Address - Phone:207-841-5489
Mailing Address - Fax:
Practice Address - Street 1:915 MAYNE ST
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637-9756
Practice Address - Country:US
Practice Address - Phone:207-841-5489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1522204D00000X
CODR.0066995204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME022904OtherBC/BS
ME333930000Medicaid
ME3552748OtherAETNA
MEG39038OtherHARVARD PILGRAM
ME50ME03079ME02OtherBLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM