Provider Demographics
NPI:1023031028
Name:SWANEY, ANGALEE R (NP)
Entity Type:Individual
Prefix:
First Name:ANGALEE
Middle Name:R
Last Name:SWANEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:120 N ASHWOOD AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1810
Practice Address - Country:US
Practice Address - Phone:805-658-5800
Practice Address - Fax:805-642-1928
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324311163W00000X
CA11095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08608FMedicaid
CAZZT40394FMedicaid
CARHM18553HMedicaid
CA95-1683892OtherOTHER INSURANCE
CARHM08609FMedicaid
CAWNP11095FMedicare ID - Type UnspecifiedPPIN
CAWNP11095CMedicare ID - Type UnspecifiedPPIN
CA95-1683892OtherOTHER INSURANCE
CAWNP11095BMedicare ID - Type UnspecifiedPPIN
CARHM08609FMedicaid
CAWNP11095DMedicare ID - Type UnspecifiedPPIN
CARHM18553HMedicaid