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General NPI Number Information
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NPI Number | 1063511061
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Entity Type | Individual
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Provider Name | TINA LORENE SWANKE OTR
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 147 N STATE ST
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City | BERLIN
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State | WI
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Zip | 54923-1621
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Country | US
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Telephone | 920-361-3515
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Fax |
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Provider Business Mailing Address
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Address Line | N6681 COUNTY RD N
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City | PRINCETON
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State | WI
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Zip | 54968-9323
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Country | US
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Telephone | 920-229-0955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 729-026
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License Number State | WI
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