Provider Demographics
NPI:1225700404
Name:LUDWIG, MARY M
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:LUDWIG
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 1:618 3RD ST
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:SD
Mailing Address - Zip Code:57451-2115
Mailing Address - Country:US
Mailing Address - Phone:160-571-5787
Mailing Address - Fax:
Practice Address - Street 1:618 3RD ST
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:SD
Practice Address - Zip Code:57451-2115
Practice Address - Country:US
Practice Address - Phone:160-571-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251J00000XAgenciesNursing Care