Provider Demographics
NPI:1528344959
Name:SWIFT, JACQUELYN MARIE (LNP)
Entity type:Individual
Prefix:MR
First Name:JACQUELYN
Middle Name:MARIE
Last Name:SWIFT
Suffix:
Gender:F
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:158 SWIFT LANE
Mailing Address - City:SOUTH NEW BERLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13843-0132
Mailing Address - Country:US
Mailing Address - Phone:607-859-2731
Mailing Address - Fax:
Practice Address - Street 1:158 SWIFT LANE
Practice Address - Street 2:
Practice Address - City:SOUTH NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13843-0132
Practice Address - Country:US
Practice Address - Phone:607-859-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127592-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse