Healthcare Provider Details

I. General information

NPI: 1760188452
Provider Name (Legal Business Name): JENNIFER SIEBER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 EAST AVE
ROCHESTER NY
14610-2515
US

IV. Provider business mailing address

195 INTREPID LN
SYRACUSE NY
13205-2548
US

V. Phone/Fax

Practice location:
  • Phone: 585-244-1280
  • Fax: 315-254-2003
Mailing address:
  • Phone: 315-469-8700
  • Fax: 315-254-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF310784
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: