Healthcare Provider Details

I. General information

NPI: 1801200068
Provider Name (Legal Business Name): JENNIFER SWIFT MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 ELM ST
NAPA CA
94559-3721
US

IV. Provider business mailing address

PO BOX 10023
NAPA CA
94581-2023
US

V. Phone/Fax

Practice location:
  • Phone: 707-253-4642
  • Fax: 707-253-6172
Mailing address:
  • Phone: 707-350-6873
  • Fax: 707-253-6172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: