Individual
ABBIE LYN SIEBENHAAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
6360 S 3000 E, STE 310, SALT LAKE CITY, UT 84121-6923
(801) 944-3199
(801) 944-3180
Mailing address
6360 S 3000 E, STE 220, SALT LAKE CITY, UT 84121-6923
(801) 944-3199
(801) 944-3180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9505091-1206
UT
363AM0700X
Medical Physician Assistant
Primary
9505091-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5059
AZ LIC
AZ
01
—
9505091-1206
UT LICENSE
UT
Enumeration date
12/05/2011
Last updated
10/14/2015
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