Provider Demographics
NPI:1336884758
Name:SWAIN, EDINE (MICROPIGMENTATION SP)
Entity type:Individual
Prefix:
First Name:EDINE
Middle Name:
Last Name:SWAIN
Suffix:
Gender:F
Credentials:MICROPIGMENTATION SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-128 AIEA HEIGHTS DR STE 102A
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3916
Mailing Address - Country:US
Mailing Address - Phone:808-220-4920
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 102A
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3916
Practice Address - Country:US
Practice Address - Phone:808-220-4920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI374700000X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty