Provider Demographics
NPI:1912785965
Name:SIEBERS, REGINA LYNN
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:LYNN
Last Name:SIEBERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NM
Mailing Address - Zip Code:88415-2900
Mailing Address - Country:US
Mailing Address - Phone:505-230-4641
Mailing Address - Fax:
Practice Address - Street 1:834 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NM
Practice Address - Zip Code:88415-2900
Practice Address - Country:US
Practice Address - Phone:575-729-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator