MEDICARE: TERRI LEIGH SWAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2020038204	OH

General Provider Information

NPI Number	:	1124616024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI LEIGH SWAN APRN

Provider Business Mailing Address
First Line	:	2899 BERGER RD
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-9447
Country	:	US
Telephone Number	:	740-815-3971
Fax Number	:

Provider Business Practice Location Address
First Line	:	2899 BERGER RD
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-9447
Country	:	US
Telephone Number	:	740-815-3971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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