Healthcare Provider Details

I. General information

NPI: 1396239869
Provider Name (Legal Business Name): MARSHA LONG SEIBERT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MAIN ST
FRANKLINTON LA
70438
US

IV. Provider business mailing address

PO BOX 3370
COVINGTON LA
70434-3370
US

V. Phone/Fax

Practice location:
  • Phone: 985-839-4431
  • Fax:
Mailing address:
  • Phone: 985-400-5988
  • Fax: 985-867-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberAP10034
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10034
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: