Provider Demographics
NPI:1275719023
Name:SPEIDEL, DONNA M
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:SPEIDEL
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 1:4660 THORNBURG DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-8810
Mailing Address - Country:US
Mailing Address - Phone:701-222-1106
Mailing Address - Fax:
Practice Address - Street 1:4660 THORNBURG DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-8810
Practice Address - Country:US
Practice Address - Phone:701-222-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography