Provider Demographics
NPI:1487241667
Name:SWENDIMAN, SHAWNA (RN)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:SWENDIMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 MEADOW GREEN RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:WI
Mailing Address - Zip Code:54830-9543
Mailing Address - Country:US
Mailing Address - Phone:651-808-2052
Mailing Address - Fax:
Practice Address - Street 1:3424 MEADOW GREEN RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:WI
Practice Address - Zip Code:54830-9543
Practice Address - Country:US
Practice Address - Phone:651-808-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI243216-30163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice