Provider Demographics
NPI:1588199699
Name:JONDLE, CHRISTINE KAY (MANT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:KAY
Last Name:JONDLE
Suffix:
Gender:F
Credentials:MANT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:KAY
Other - Last Name:JONDLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:215 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2424
Mailing Address - Country:US
Mailing Address - Phone:515-570-5883
Mailing Address - Fax:
Practice Address - Street 1:215 10TH AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2424
Practice Address - Country:US
Practice Address - Phone:515-570-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA81-4490147247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other