Healthcare Provider Details

I. General information

NPI: 1902202070
Provider Name (Legal Business Name): NICOLA ZWASCHKA RDH,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E. NIAGARA ROAD
MONTROSE CO
81401-5027
US

IV. Provider business mailing address

PO BOX 183
MONTROSE CO
81402-0183
US

V. Phone/Fax

Practice location:
  • Phone: 970-497-4921
  • Fax: 970-701-4161
Mailing address:
  • Phone: 970-209-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH000201748
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: