Provider Demographics
NPI:1073841284
Name:REBHAHN, TONYA RACHELLE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:RACHELLE
Last Name:REBHAHN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:TONYA
Other - Middle Name:RACHELLE
Other - Last Name:MIKELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:W5830 KOSS RD
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8833
Mailing Address - Country:US
Mailing Address - Phone:608-781-2582
Mailing Address - Fax:
Practice Address - Street 1:W5830 KOSS RD
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8833
Practice Address - Country:US
Practice Address - Phone:608-781-2582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-28
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6793-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist