Provider Demographics
NPI:1053829721
Name:SCHWALBE, RHONDA JEAN
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:JEAN
Last Name:SCHWALBE
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 1:4102 KENTUCKY AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55427-1326
Mailing Address - Country:US
Mailing Address - Phone:612-229-6063
Mailing Address - Fax:
Practice Address - Street 1:727 4TH ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2369
Practice Address - Country:US
Practice Address - Phone:218-741-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10012124Q00000X
MN88125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
No124Q00000XDental ProvidersDental Hygienist