=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184214082
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER ANN-MARIE SIBEL CRNP, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2021
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 HORIZON DR STE 101
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18914-3970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-489-9170
-----------------------------------------------------
Fax | 215-489-9174
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 HORIZON DR STE 101
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18914-3970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-489-9170
-----------------------------------------------------
Fax | 215-489-9174
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | LG-0011560
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------