Provider Demographics
NPI:1104974963
Name:SWISHER, SANDRA ELLEN (FNP BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELLEN
Last Name:SWISHER
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-2706
Mailing Address - Country:US
Mailing Address - Phone:304-428-0815
Mailing Address - Fax:
Practice Address - Street 1:1200 STEPHENSON AVENUE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4936
Practice Address - Country:US
Practice Address - Phone:304-420-5819
Practice Address - Fax:304-422-8850
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV34047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7105014000Medicaid
WV7105014000Medicaid
S75168Medicare UPIN