Healthcare Provider Details

I. General information

NPI: 1003281098
Provider Name (Legal Business Name): JENNIFER SWARTOUT LDN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 GUILFORD AVE
BALTIMORE MD
21218-5221
US

IV. Provider business mailing address

2417 GUILFORD AVE
BALTIMORE MD
21218-5221
US

V. Phone/Fax

Practice location:
  • Phone: 410-542-2010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX3827
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: