Healthcare Provider Details

I. General information

NPI: 1861268302
Provider Name (Legal Business Name): HEATHER LUREE SWAENEPOEL MSN, ACCNS-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22101 MOROSS RD
DETROIT MI
48236-2148
US

IV. Provider business mailing address

28124 ROCKWOOD ST
SAINT CLAIR SHORES MI
48081-1454
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-4000
  • Fax:
Mailing address:
  • Phone: 586-854-8795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4704330717
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: