Provider Demographics
NPI:1003260670
Name:SWOPE, AUDREY (STNA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:SWOPE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-1012
Mailing Address - Country:US
Mailing Address - Phone:440-983-1046
Mailing Address - Fax:
Practice Address - Street 1:1510 GLENVIEW AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-1012
Practice Address - Country:US
Practice Address - Phone:440-983-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0160185Medicaid