Provider Demographics
NPI:1366208340
Name:HOLYBEAR, SIBASHTON TRE
Entity type:Individual
Prefix:
First Name:SIBASHTON
Middle Name:TRE
Last Name:HOLYBEAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:ND
Mailing Address - Zip Code:58577-4221
Mailing Address - Country:US
Mailing Address - Phone:701-979-5522
Mailing Address - Fax:
Practice Address - Street 1:927 MAIN AVE
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:ND
Practice Address - Zip Code:58577-4221
Practice Address - Country:US
Practice Address - Phone:701-979-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist