Doctor Name: | JAYME L SIBLEY |
NPI Number: | 1346521770 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 085.003842 |
Business Practice Address: | 5031 N Illinois St Fairview Heights, IL - 622083453 |
Business Phone Number: | 6182126800 |
Business Fax Number: | 6182126820 |
Mailing Address: | 5031 N Illinois St, FAIRVIEW HEIGHTS |
State: | IL |
Postal Code: | 622083453 |
Phone Number: | 6182126800 |
Fax Number: | 6182126820 |
NPI Enumeration Date: | 08/30/2011 |
NPI Last Update Date: | 12/22/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 085.003842 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |