Provider Demographics
NPI:1962734962
Name:SWANSON, WENDY (LAC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 CHATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3626
Mailing Address - Country:US
Mailing Address - Phone:704-305-6389
Mailing Address - Fax:704-334-5374
Practice Address - Street 1:1708 CHATHAM AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-3626
Practice Address - Country:US
Practice Address - Phone:704-305-6389
Practice Address - Fax:704-334-5374
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC455171100000X
SC108171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist