Provider Demographics
NPI:1144894528
Name:SIBLEY, AMY BETH (CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:SIBLEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 SLOAN PL STE 17
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2051
Mailing Address - Country:US
Mailing Address - Phone:651-772-6251
Mailing Address - Fax:
Practice Address - Street 1:1997 SLOAN PL STE 17
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55117-2051
Practice Address - Country:US
Practice Address - Phone:651-772-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily