Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6793-016 | WI |
NPI | 1073841284 |
---|---|
Provider Name | Mrs. Tonya Rachelle Rebhahn |
First Address | Onalaska, WI 54650-8833 |
Second Address | Onalaska, WI 54650-8833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2009 |
Last Update Date | 28/11/2009 |