Provider Demographics
NPI:1679608202
Name:ZIECKER, MARA ELIZABETH (DOM)
Entity type:Individual
Prefix:MRS
First Name:MARA
Middle Name:ELIZABETH
Last Name:ZIECKER
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2802 19TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1700
Mailing Address - Country:US
Mailing Address - Phone:505-891-9871
Mailing Address - Fax:505-891-9871
Practice Address - Street 1:2802 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1700
Practice Address - Country:US
Practice Address - Phone:505-891-9871
Practice Address - Fax:505-891-9871
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM899171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist