Provider Demographics
NPI:1891317558
Name:SEIBER, SAMANTHA ASHLEY (LPN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ASHLEY
Last Name:SEIBER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 KNOXVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-3101
Mailing Address - Country:US
Mailing Address - Phone:865-771-4695
Mailing Address - Fax:
Practice Address - Street 1:2226 KNOXVILLE HWY
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-3101
Practice Address - Country:US
Practice Address - Phone:865-771-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN774990164W00000X
TN74990164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty