Healthcare Provider Details

I. General information

NPI: 1770998791
Provider Name (Legal Business Name): JEMA SWANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 PRAIRIE MEADOW DR
IOWA CITY IA
52242-8001
US

IV. Provider business mailing address

1446 P AVE
CLARINDA IA
51632-5074
US

V. Phone/Fax

Practice location:
  • Phone: 712-303-1355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: