Provider Demographics
NPI:1962618728
Name:SWANGER, ERICA ANNE (LMP)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:ANNE
Last Name:SWANGER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 S BLAINE ST STE 21
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3973
Mailing Address - Country:US
Mailing Address - Phone:360-961-3751
Mailing Address - Fax:
Practice Address - Street 1:1420 S BLAINE ST STE 21
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3973
Practice Address - Country:US
Practice Address - Phone:360-961-3751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARF60485502173C00000X
WAMA00017620225700000X
IDMAS2488225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist