Provider Demographics
NPI:1710258363
Name:ZIELKE, DONNA JANE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JANE
Last Name:ZIELKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W4153 APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-9219
Mailing Address - Country:US
Mailing Address - Phone:715-678-2543
Mailing Address - Fax:
Practice Address - Street 1:W4153 APPLE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-9219
Practice Address - Country:US
Practice Address - Phone:715-678-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI314412164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse