Provider Demographics
NPI:1952787830
Name:SIEBEN, SHERRY Y (MT)
Entity Type:Individual
Prefix:MISS
First Name:SHERRY
Middle Name:Y
Last Name:SIEBEN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 MILO ST
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5462
Mailing Address - Country:US
Mailing Address - Phone:907-888-7472
Mailing Address - Fax:
Practice Address - Street 1:3039 DAVIS RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5234
Practice Address - Country:US
Practice Address - Phone:907-452-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK964605225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist