=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477903797
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSEY SWISCHUK APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2016
-----------------------------------------------------
Last Update Date | 06/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 114 W STRATFORD DR
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61614-7301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-740-4272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 OAKWOOD RD
-----------------------------------------------------
City | EAST PEORIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61611-1853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-740-4272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364S00000X
-----------------------------------------------------
Taxonomy Name | Clinical Nurse Specialist
-----------------------------------------------------
License Number | 209.014343
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------