Individual
MS. LYDIA GRACE SEIBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1801 N JACKSON ST, TULLAHOMA, TN 37388-8259
(615) 971-0570
Mailing address
122 WOLVERINE CT, SMYRNA, TN 37167-6814
(615) 971-0570
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3694
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/02/2017
Last updated
02/05/2019
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