Healthcare Provider Details

I. General information

NPI: 1760348288
Provider Name (Legal Business Name): SANDRA LYNN SIEBUHR LICENSED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 CENTRAL AVE SE
ALBUQUERQUE NM
87106-2862
US

IV. Provider business mailing address

425 69TH ST SW
ALBUQUERQUE NM
87121-2457
US

V. Phone/Fax

Practice location:
  • Phone: 505-559-4268
  • Fax:
Mailing address:
  • Phone: 918-289-0270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL11249
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: