Healthcare Provider Details

I. General information

NPI: 1891973244
Provider Name (Legal Business Name): JOLYN M SEIBERT R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2472 W. LADLE RAPIDS STREET
MERIDIAN ID
83646-4771
US

IV. Provider business mailing address

2472 W LADLE RAPIDS ST
MERIDIAN ID
83646-4771
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-3883
  • Fax: 208-493-3087
Mailing address:
  • Phone: 208-343-3883
  • Fax: 208-493-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD043
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: