Healthcare Provider Details

I. General information

NPI: 1407302110
Provider Name (Legal Business Name): JASMINE SWANIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2753 W NORTH AVE FLOOR 3
CHICAGO IL
60647
US

IV. Provider business mailing address

8553 S MORGAN FLOOR 2
CHICAGO IL
60620
US

V. Phone/Fax

Practice location:
  • Phone: 312-814-2920
  • Fax:
Mailing address:
  • Phone: 872-904-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: