Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 35.128065 | OH |
Y | 208600000X | Surgeon | 35.128065 | OH |
N | 2086S0102X | Surgical Critical Care | 35.128065 | OH |
NPI | 1114247251 |
---|---|
Provider Name | Christa Siebenburgen |
First Address | Kettering, OH 45429-1264 |
Second Address | Kettering, OH 45429-1264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2010 |
Last Update Date | 23/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0165743 | (05) | OH |