Healthcare Provider Details

I. General information

NPI: 1598491029
Provider Name (Legal Business Name): JASON JAMES SWANKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 FULTON ST E
GRAND RAPIDS MI
49503-3849
US

IV. Provider business mailing address

2478 HARDING AVE
MUSKEGON MI
49441-1248
US

V. Phone/Fax

Practice location:
  • Phone: 616-742-0351
  • Fax:
Mailing address:
  • Phone: 616-387-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: