Healthcare Provider Details

I. General information

NPI: 1093130940
Provider Name (Legal Business Name): MICHELLE KEATING-SIBEL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2014
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S BROAD ST
LANSDALE PA
19446-5393
US

IV. Provider business mailing address

1101 S BROAD ST
LANSDALE PA
19446-5393
US

V. Phone/Fax

Practice location:
  • Phone: 484-246-5006
  • Fax: 484-246-5006
Mailing address:
  • Phone: 484-246-5006
  • Fax: 484-246-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013722
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: