Provider Demographics
NPI:1578540290
Name:ZIEBARTH, DONILYN L (PA-C)
Entity Type:Individual
Prefix:
First Name:DONILYN
Middle Name:L
Last Name:ZIEBARTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-1634
Mailing Address - Country:US
Mailing Address - Phone:605-256-6951
Mailing Address - Fax:605-256-6952
Practice Address - Street 1:903 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-1634
Practice Address - Country:US
Practice Address - Phone:605-256-6951
Practice Address - Fax:605-256-6952
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0068363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6820690Medicaid
SD6820690Medicaid
SDR02472Medicare UPIN