Healthcare Provider Details

I. General information

NPI: 1255380689
Provider Name (Legal Business Name): NANCY LYNN SWIGONSKI M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6067 DECATUR BLVD
INDIANAPOLIS IN
46241-9606
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-5201
  • Fax:
Mailing address:
  • Phone: 317-274-1201
  • Fax: 317-278-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01033713A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: