MEDICARE: LISA SWANSON

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1518383272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SWANSON

Provider Business Mailing Address
First Line	:	1026 23RD ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-5745
Country	:	US
Telephone Number	:	561-503-6433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 23RD ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-5745
Country	:	US
Telephone Number	:	561-503-6433
Fax Number	:

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

Provider Enumeration Date	:	03/05/2014
Last Update Date	:	03/06/2014

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Directions to “ LISA SWANSON ” Practice Location

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