Healthcare Provider Details

I. General information

NPI: 1598686305
Provider Name (Legal Business Name): RENEE MARIE SWANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 COUNTY ROAD T
MARSHALL WI
53559-9735
US

IV. Provider business mailing address

331 WILLOW ST
PARDEEVILLE WI
53954-8505
US

V. Phone/Fax

Practice location:
  • Phone: 608-988-6472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1002913-16
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: