Provider Demographics
NPI:1285002261
Name:SWAN, WILLIAM IRVING (RDN, LD, FAND)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:IRVING
Last Name:SWAN
Suffix:
Gender:M
Credentials:RDN, LD, FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 PASEO DEL PUEBLO SUR # 171
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5972
Mailing Address - Country:US
Mailing Address - Phone:443-895-8007
Mailing Address - Fax:
Practice Address - Street 1:76 C TOMAS H. ROMERO RD
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557
Practice Address - Country:US
Practice Address - Phone:575-737-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0904133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered