Healthcare Provider Details

I. General information

NPI: 1225045412
Provider Name (Legal Business Name): JEANETTE S SWAYZE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 COUNTY ROAD 515
IGNACIO CO
81137-9711
US

IV. Provider business mailing address

649 COUNTY ROAD 515
IGNACIO CO
81137-9711
US

V. Phone/Fax

Practice location:
  • Phone: 970-884-2479
  • Fax:
Mailing address:
  • Phone: 970-884-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR16525
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: