Healthcare Provider Details

I. General information

NPI: 1790715530
Provider Name (Legal Business Name): CHARLOTTE ANN SWINDAL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E. NIZHONI BLVD.
GALLUP NM
87301-1337
US

IV. Provider business mailing address

BOX 1337 516 E. NIZHONI BLVD.
GALLUP NM
87301-1337
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax: 505-722-1310
Mailing address:
  • Phone: 505-722-1000
  • Fax: 505-722-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN061728
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000829-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: