Provider Demographics
NPI:1043606007
Name:DUTTENHEFNER-ZIEGLER, MARKELLE
Entity Type:Individual
Prefix:
First Name:MARKELLE
Middle Name:
Last Name:DUTTENHEFNER-ZIEGLER
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 1:1306 APACHE ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2631
Mailing Address - Country:US
Mailing Address - Phone:701-202-9415
Mailing Address - Fax:
Practice Address - Street 1:1306 APACHE ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2631
Practice Address - Country:US
Practice Address - Phone:701-202-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program