Healthcare Provider Details

I. General information

NPI: 1972509826
Provider Name (Legal Business Name): JEAN M SWANEY C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 WILLIAMSBURG WAY NE
LOUISVILLE OH
44641-8781
US

IV. Provider business mailing address

1917 WILLIAMSBURG WAY NE
LOUISVILLE OH
44641-8781
US

V. Phone/Fax

Practice location:
  • Phone: 330-875-3366
  • Fax: 330-875-1106
Mailing address:
  • Phone: 330-875-3366
  • Fax: 330-875-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN142804
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: