Provider Demographics
NPI:1164829990
Name:SWARD, MIRIAM AMBER (APNP)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:AMBER
Last Name:SWARD
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 W KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1307
Mailing Address - Country:US
Mailing Address - Phone:715-236-4450
Mailing Address - Fax:715-236-1831
Practice Address - Street 1:1215 W KNAPP ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1307
Practice Address - Country:US
Practice Address - Phone:715-236-4450
Practice Address - Fax:715-236-1831
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6094-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner