Provider Demographics
NPI:1447742390
Name:SEIBERT, MICHELLE LEEANN (CNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEEANN
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 DELAVAN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3551
Mailing Address - Country:US
Mailing Address - Phone:937-361-8401
Mailing Address - Fax:
Practice Address - Street 1:2821 DELAVAN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3551
Practice Address - Country:US
Practice Address - Phone:937-361-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily