Provider Demographics
NPI:1306104625
Name:SWINNEY, JEANELLE NICOLE
Entity type:Individual
Prefix:MISS
First Name:JEANELLE
Middle Name:NICOLE
Last Name:SWINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JEANELLE
Other - Middle Name:NICOLE
Other - Last Name:SWINNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15095 AMARGOSA RD
Mailing Address - Street 2:SUITE201
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1879
Mailing Address - Country:US
Mailing Address - Phone:760-245-4695
Mailing Address - Fax:760-513-4676
Practice Address - Street 1:15095 AMARGOSA RD
Practice Address - Street 2:SUITE201
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1879
Practice Address - Country:US
Practice Address - Phone:760-245-4695
Practice Address - Fax:760-513-4676
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker