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NPI Code Detail

MEDICARE: LORI BETH SIBLEY RN

MEDICARE: LORI BETH SIBLEY RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse368155NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122 368155OTHERNYNURSING LICENSE

General Provider Information

NPI Number : 1386952224
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI BETH SIBLEY RN
Provider Business Mailing Address
First Line : 55 BROWN RD
Second Line :
City : ITHACA
State : NY
Zip : 14850-1247
Country : US
Telephone Number : 607-274-6604
Fax Number : 607-274-6620
Provider Business Practice Location Address
First Line : 55 BROWN RD
Second Line :
City : ITHACA
State : NY
Zip : 14850-1247
Country : US
Telephone Number : 607-274-6604
Fax Number : 607-274-6620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2010
Last Update Date : 09/14/2010

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