Individual
ANDREW SIEBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
304 SEA HUNTER WAY, SNEADS FERRY, NC 28460-6012
(860) 462-2636
Mailing address
304 SEA HUNTER WAY, SNEADS FERRY, NC 28460-6012
(860) 462-2636
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L02A
SOIDC
NC
Enumeration date
09/30/2019
Last updated
09/30/2019
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