Provider Demographics
NPI:1386331239
Name:SIEBERT, MAGGIE KATHERINE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:KATHERINE
Last Name:SIEBERT
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4332 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1406
Mailing Address - Country:US
Mailing Address - Phone:319-310-7850
Mailing Address - Fax:
Practice Address - Street 1:4332 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1406
Practice Address - Country:US
Practice Address - Phone:319-310-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-157796163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant