Provider Demographics
NPI:1346208964
Name:HARTZELL, MARYANNE (MD)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:HARTZELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARYANNE
Other - Middle Name:
Other - Last Name:SKAVDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1508 ELDORADO RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3035
Mailing Address - Country:US
Mailing Address - Phone:402-640-9562
Mailing Address - Fax:
Practice Address - Street 1:110 N 29TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4424
Practice Address - Country:US
Practice Address - Phone:402-844-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227669207R00000X
NE26205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine