Healthcare Provider Details

I. General information

NPI: 1033608385
Provider Name (Legal Business Name): SUZANN SWETLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 GREGORY PL
JACKSON MI
49202-2608
US

IV. Provider business mailing address

510 GREGORY PL
JACKSON MI
49202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 517-750-7784
  • Fax:
Mailing address:
  • Phone: 517-750-7784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703089458
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: