MEDICARE: DR. MONASE MICKNESS CHIBAMBO SWANIGAN NP

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	363LG0600X	Gerontology Nurse Practitioner	4704303464	MI

General Provider Information

NPI Number	:	1265267405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONASE MICKNESS CHIBAMBO SWANIGAN NP

Provider Business Mailing Address
First Line	:	3622 NOTTINGHAM DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-1361
Country	:	US
Telephone Number	:	616-970-9610
Fax Number	:

Provider Business Practice Location Address
First Line	:	3622 NOTTINGHAM DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-1361
Country	:	US
Telephone Number	:	616-970-9610
Fax Number	:

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

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	06/05/2025

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