MEDICARE: MS. MARTHA HYDE SWAN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	041.175644	IL

General Provider Information

NPI Number	:	1154690527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA HYDE SWAN RN

Provider Business Mailing Address
First Line	:	3316 RT. 173
Second Line	:	PO BOX 53
City	:	RICHMOND
State	:	IL
Zip	:	60071-9614
Country	:	US
Telephone Number	:	847-715-8483
Fax Number	:

Provider Business Practice Location Address
First Line	:	3316 RT. 173
Second Line	:
City	:	RICHMOND
State	:	IL
Zip	:	60071-9614
Country	:	US
Telephone Number	:	847-715-8483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	02/08/2026

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