Provider Demographics
NPI:1093960973
Name:SWAN-RICKARD, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SWAN-RICKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 SMITH STEWART RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44473-8604
Mailing Address - Country:US
Mailing Address - Phone:330-770-0298
Mailing Address - Fax:
Practice Address - Street 1:4950 SMITH STEWART RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:OH
Practice Address - Zip Code:44473-8604
Practice Address - Country:US
Practice Address - Phone:330-770-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH084470164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse