Healthcare Provider Details

I. General information

NPI: 1902932692
Provider Name (Legal Business Name): EILEEN M SWAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN M. THOMAS NP

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 ELIZABETH AVE STE 201
SHREVEPORT LA
71101-4531
US

IV. Provider business mailing address

1534 ELIZABETH AVE STE 301
SHREVEPORT LA
71101-4531
US

V. Phone/Fax

Practice location:
  • Phone: 318-629-5505
  • Fax: 318-629-5506
Mailing address:
  • Phone: 318-629-5001
  • Fax: 318-629-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN102394
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP04798
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: