Healthcare Provider Details

I. General information

NPI: 1144894528
Provider Name (Legal Business Name): AMY BETH SIBLEY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1997 SLOAN PL STE 17
MAPLEWOOD MN
55117-2051
US

IV. Provider business mailing address

1997 SLOAN PL STE 17
MAPLEWOOD MN
55117-2051
US

V. Phone/Fax

Practice location:
  • Phone: 651-772-6251
  • Fax:
Mailing address:
  • Phone: 651-772-6251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8152
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: