Healthcare Provider Details

I. General information

NPI: 1790739142
Provider Name (Legal Business Name): SYDNEY MAE SWETNAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

PO BOX 3340
DURANGO CO
81302-3340
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1090
  • Fax:
Mailing address:
  • Phone: 505-563-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberNM-85110
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: