Provider Demographics
NPI:1306593207
Name:SWALLOW, MARGARITA ANGELINA (LPN)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:ANGELINA
Last Name:SWALLOW
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 1:3608 JASON AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-2041
Mailing Address - Country:US
Mailing Address - Phone:208-427-5459
Mailing Address - Fax:
Practice Address - Street 1:1071 RENEE AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2508
Practice Address - Country:US
Practice Address - Phone:208-233-1411
Practice Address - Fax:208-233-1515
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID54640164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse