Provider Demographics
NPI:1558059022
Name:SKRIVER, ROSEMARY E (LDH, ADT)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:E
Last Name:SKRIVER
Suffix:
Gender:F
Credentials:LDH, ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 NORTH CT
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-1431
Mailing Address - Country:US
Mailing Address - Phone:319-201-0099
Mailing Address - Fax:
Practice Address - Street 1:3 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:MN
Practice Address - Zip Code:55741-5007
Practice Address - Country:US
Practice Address - Phone:846-121-8248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH11405124Q00000X
MNDT163125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist
No124Q00000XDental ProvidersDental Hygienist