Healthcare Provider Details

I. General information

NPI: 1043082084
Provider Name (Legal Business Name): ALYSON SWINGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MILL ST STE 210
COLUMBUS OH
43230-6545
US

IV. Provider business mailing address

2350 GAVINLEY WAY
COLUMBUS OH
43220-7334
US

V. Phone/Fax

Practice location:
  • Phone: 740-407-6331
  • Fax:
Mailing address:
  • Phone: 614-579-8201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberAPRN.CNP.0033018
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN.CNP.0033018
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: