Healthcare Provider Details

I. General information

NPI: 1750526810
Provider Name (Legal Business Name): SHANDA CONRAD SWAGLER F NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANDA CONRAD

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N PARK AVE
HERRIN IL
62948-3150
US

IV. Provider business mailing address

220 N PARK AVE
HERRIN IL
62948-3150
US

V. Phone/Fax

Practice location:
  • Phone: 618-942-3344
  • Fax:
Mailing address:
  • Phone: 618-942-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-007322
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: