Provider Demographics
NPI:1154690527
Name:SWAN, MARTHA HYDE (RN)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:HYDE
Last Name:SWAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 RT. 173
Mailing Address - Street 2:PO BOX 53
Mailing Address - City:RICHMOND
Mailing Address - State:IL
Mailing Address - Zip Code:60071-9614
Mailing Address - Country:US
Mailing Address - Phone:847-715-8483
Mailing Address - Fax:
Practice Address - Street 1:3316 RT. 173
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IL
Practice Address - Zip Code:60071-9614
Practice Address - Country:US
Practice Address - Phone:847-715-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.175644163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health