Provider Demographics
NPI:1912124223
Name:SHEELER, RHONDA RENEE (LD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:RENEE
Last Name:SHEELER
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-3413
Mailing Address - Country:US
Mailing Address - Phone:360-575-1667
Mailing Address - Fax:360-575-9190
Practice Address - Street 1:205 N PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-3413
Practice Address - Country:US
Practice Address - Phone:360-575-1667
Practice Address - Fax:360-575-9190
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000334122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist