Provider Demographics
NPI:1306175344
Name:SWINGEN, KELLY (LPN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:SWINGEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 S HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3027
Mailing Address - Country:US
Mailing Address - Phone:920-743-6806
Mailing Address - Fax:
Practice Address - Street 1:318 S HUDSON AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3027
Practice Address - Country:US
Practice Address - Phone:920-743-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13467-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse