Healthcare Provider Details

I. General information

NPI: 1801493861
Provider Name (Legal Business Name): MARK SWAFFORD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE
LAS CRUCES NM
88001-3172
US

IV. Provider business mailing address

2932 DEVILS TOWER CIR
EL PASO TX
79904-2405
US

V. Phone/Fax

Practice location:
  • Phone: 575-405-4062
  • Fax:
Mailing address:
  • Phone: 423-667-8797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP146173
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61560
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: