Healthcare Provider Details

I. General information

NPI: 1174392500
Provider Name (Legal Business Name): CRISTA NICOLE SWIFT LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9919 5TH PL SE
LAKE STEVENS WA
98258-2063
US

IV. Provider business mailing address

9919 5TH PL SE
LAKE STEVENS WA
98258-2063
US

V. Phone/Fax

Practice location:
  • Phone: 425-918-2362
  • Fax:
Mailing address:
  • Phone: 425-918-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMIDW.MW.70164695
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: