Provider Demographics
NPI:1093021149
Name:SWIFT, CHARISSE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:CHARISSE
Middle Name:
Last Name:SWIFT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 CORKHILL RD APT 218C
Mailing Address - Street 2:N/A
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3469
Mailing Address - Country:US
Mailing Address - Phone:216-322-1779
Mailing Address - Fax:216-475-8384
Practice Address - Street 1:541 CORKHILL RD APT 218C
Practice Address - Street 2:N/A
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3469
Practice Address - Country:US
Practice Address - Phone:216-322-1779
Practice Address - Fax:216-475-8384
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH305177163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse