Healthcare Provider Details

I. General information

NPI: 1275980971
Provider Name (Legal Business Name): JESSICA EDENS SWAN MSM, LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13128 TOTEM LAKE BLVD NE SUITE 101
KIRKLAND WA
98034-2953
US

IV. Provider business mailing address

13128 TOTEM LAKE BLVD NE SUITE 101
KIRKLAND WA
98034-2953
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-1919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number60569358
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: