Provider Demographics
NPI:1427293372
Name:SWANBERG, ROSE ANN
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:ANN
Last Name:SWANBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3262
Mailing Address - Country:US
Mailing Address - Phone:815-748-3933
Mailing Address - Fax:
Practice Address - Street 1:130 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3262
Practice Address - Country:US
Practice Address - Phone:815-748-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician