Provider Demographics
NPI:1033311139
Name:SWENDRA, CHRISTINA MAE (MOTRL)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MAE
Last Name:SWENDRA
Suffix:
Gender:F
Credentials:MOTRL
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:MAE
Other - Last Name:STOCKFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTRL
Mailing Address - Street 1:4342 15TH AVE S STE 105
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1125
Mailing Address - Country:US
Mailing Address - Phone:701-936-9495
Mailing Address - Fax:952-222-1994
Practice Address - Street 1:4342 15TH AVE S STE 105
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1125
Practice Address - Country:US
Practice Address - Phone:701-936-9495
Practice Address - Fax:952-222-1994
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103239225X00000X
ND1032225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND56176Medicaid
ND56176Medicaid