=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750675799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA SWAN FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2011
-----------------------------------------------------
Last Update Date | 11/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 WINOOSKI FALLS WAY SUITE 400
-----------------------------------------------------
City | WINOOSKI
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05404-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-857-0458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 SOUTHWIND DR
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05401-5465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-338-2372
-----------------------------------------------------
Fax | 802-419-4773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 101.0015938
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------