Healthcare Provider Details

I. General information

NPI: 1124839436
Provider Name (Legal Business Name): SYDNEY SCHWINGHAMMER RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

19052 DEERWOOD RD
CLEARWATER MN
55320-1404
US

V. Phone/Fax

Practice location:
  • Phone: 320-255-6396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2438638
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: