Healthcare Provider Details

I. General information

NPI: 1760365688
Provider Name (Legal Business Name): JENNIFER L SIBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER L CANOY

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12806 ROYAL GRAND
REDFORD MI
48239-2667
US

IV. Provider business mailing address

PO BOX 701254
PLYMOUTH MI
48170-0961
US

V. Phone/Fax

Practice location:
  • Phone: 248-910-7396
  • Fax: 248-910-7396
Mailing address:
  • Phone: 248-910-7396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: