MEDICARE: ANGEL I SWAN

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1710777198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL I SWAN

Provider Business Mailing Address
First Line	:	1353 GOODPASTURE ISLAND RD APT 7
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-1788
Country	:	US
Telephone Number	:	458-317-2008
Fax Number	:

Provider Business Practice Location Address
First Line	:	1353 GOODPASTURE ISLAND RD APT 7
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-1788
Country	:	US
Telephone Number	:	458-317-2008
Fax Number	:

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

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	05/21/2025

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Directions to “ ANGEL I SWAN ” Practice Location

Language	Start Address	Practice Location

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