Healthcare Provider Details

I. General information

NPI: 1386204311
Provider Name (Legal Business Name): MISS HANNAH JOY SWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 SW WASHINGTON ST
DALLAS OR
97338-3413
US

IV. Provider business mailing address

7550 WILLIS CREEK RD
WINSTON OR
97496-5555
US

V. Phone/Fax

Practice location:
  • Phone: 971-240-9598
  • Fax:
Mailing address:
  • Phone: 971-240-9598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM-LD-10208835
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: