Provider Demographics
NPI:1598995466
Name:BRAATEN-ANTRIM, RHONDA KAYE
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:KAYE
Last Name:BRAATEN-ANTRIM
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 1:202 8TH ST N
Mailing Address - Street 2:PO BOX 46
Mailing Address - City:WHEATON
Mailing Address - State:MN
Mailing Address - Zip Code:56296-1461
Mailing Address - Country:US
Mailing Address - Phone:320-563-8255
Mailing Address - Fax:320-563-4230
Practice Address - Street 1:202 8TH ST N
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MN
Practice Address - Zip Code:56296-1461
Practice Address - Country:US
Practice Address - Phone:320-563-8255
Practice Address - Fax:320-563-4230
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator