Healthcare Provider Details

I. General information

NPI: 1932674769
Provider Name (Legal Business Name): CASEY SWANK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 W DELHI AVE
NORTH LAS VEGAS NV
89032-7836
US

IV. Provider business mailing address

9 W DELHI AVE
NORTH LAS VEGAS NV
89032-7836
US

V. Phone/Fax

Practice location:
  • Phone: 702-650-9900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number106159
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: