Healthcare Provider Details

I. General information

NPI: 1316185549
Provider Name (Legal Business Name): MARK L. ZIEGLER ARNP, CRNFA, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 LINDA LN
CLARKSTON WA
99403-1256
US

IV. Provider business mailing address

2419 LINDA LN
CLARKSTON WA
99403-1256
US

V. Phone/Fax

Practice location:
  • Phone: 208-553-4434
  • Fax:
Mailing address:
  • Phone: 208-553-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60167707
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberN-992A
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201250130NP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201242017RN
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberN-27433
License Number StateID
# 6
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN 00125046
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: