Healthcare Provider Details

I. General information

NPI: 1649738782
Provider Name (Legal Business Name): LINDA JACQUILINE SWAIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8610 N NEW BRAUNFELS AVE STE 405
SAN ANTONIO TX
78217-6358
US

IV. Provider business mailing address

1247 CODY LN
MARION TX
78124-2062
US

V. Phone/Fax

Practice location:
  • Phone: 210-804-0193
  • Fax:
Mailing address:
  • Phone: 210-473-8413
  • Fax: 210-494-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number570757
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: