Provider Demographics
NPI:1104533272
Name:FEQUIERE-SIBERT, MARIE ANDRELINA
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ANDRELINA
Last Name:FEQUIERE-SIBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2439
Mailing Address - Country:US
Mailing Address - Phone:908-370-2296
Mailing Address - Fax:
Practice Address - Street 1:701 WOOD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2439
Practice Address - Country:US
Practice Address - Phone:190-837-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01387300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily