Healthcare Provider Details

I. General information

NPI: 1700953502
Provider Name (Legal Business Name): JUDITH MARIA SIEBART MS ,RD, LDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 HOPWOOD FAIRCHANCE RD
UNIONTOWN PA
15401-6509
US

IV. Provider business mailing address

307 HOPWOOD FAIRCHANCE RD
UNIONTOWN PA
15401-6509
US

V. Phone/Fax

Practice location:
  • Phone: 724-439-1971
  • Fax:
Mailing address:
  • Phone: 724-439-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN001344
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN001344
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: