Provider Demographics
NPI:1992330302
Name:SIEBRANDT, MARTI (RDN)
Entity type:Individual
Prefix:
First Name:MARTI
Middle Name:
Last Name:SIEBRANDT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-0488
Mailing Address - Country:US
Mailing Address - Phone:308-345-7775
Mailing Address - Fax:
Practice Address - Street 1:106 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3645
Practice Address - Country:US
Practice Address - Phone:308-345-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS425133V00000X
NE799133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered