MEDICARE: MS. KIMBERLEE JEAN SWANSON BSN

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	163W00000X	Registered Nurse	742505	PA

General Provider Information

NPI Number	:	1831820067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLEE JEAN SWANSON BSN

Provider Business Mailing Address
First Line	:	117 1/2 VINE ST REAR APT
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-4619
Country	:	US
Telephone Number	:	843-455-7589
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 MAIN DR
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-5099
Country	:	US
Telephone Number	:	814-726-4551
Fax Number	:

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

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	06/20/2022

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