Healthcare Provider Details

I. General information

NPI: 1215974670
Provider Name (Legal Business Name): PATRICIA A SWASKO A.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SUNSET AVE
SOLDIERS GROVE WI
54655-1047
US

IV. Provider business mailing address

PO BOX 147
SOLDIERS GROVE WI
54655-0147
US

V. Phone/Fax

Practice location:
  • Phone: 608-637-4230
  • Fax: 608-637-4214
Mailing address:
  • Phone: 608-637-4230
  • Fax: 608-637-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1404
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: