Provider Demographics
NPI:1093736217
Name:SWAN-KREMEIER, LORRAINE A (PSYD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:A
Last Name:SWAN-KREMEIER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1929
Mailing Address - Country:US
Mailing Address - Phone:701-234-4111
Mailing Address - Fax:701-234-4130
Practice Address - Street 1:100 4TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1929
Practice Address - Country:US
Practice Address - Phone:701-234-4111
Practice Address - Fax:701-234-4130
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3521103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN782824100Medicaid
ND10347Medicaid
NDN15147Medicare PIN
ND10347Medicaid