Healthcare Provider Details

I. General information

NPI: 1083261879
Provider Name (Legal Business Name): CATHERINE SWAGGER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HEIGHTS RD APT A8
RIDGEWOOD NJ
07450-3147
US

IV. Provider business mailing address

25 HEIGHTS RD APT A8
RIDGEWOOD NJ
07450-3147
US

V. Phone/Fax

Practice location:
  • Phone: 615-668-8899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number382954
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR22832400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: