Provider Demographics
NPI:1679160204
Name:GUNDERSON, MARLENE KAY
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:KAY
Last Name:GUNDERSON
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 1:6699 COUNTY ROAD 6
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-9123
Mailing Address - Country:US
Mailing Address - Phone:701-360-3792
Mailing Address - Fax:
Practice Address - Street 1:509 ALMERON AVE
Practice Address - Street 2:
Practice Address - City:DRAYTON
Practice Address - State:ND
Practice Address - Zip Code:58225-4401
Practice Address - Country:US
Practice Address - Phone:701-331-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care