Provider Demographics
NPI:1225045412
Name:SWAYZE, JEANETTE S (NP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:S
Last Name:SWAYZE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 COUNTY ROAD 515
Mailing Address - Street 2:
Mailing Address - City:IGNACIO
Mailing Address - State:CO
Mailing Address - Zip Code:81137-9711
Mailing Address - Country:US
Mailing Address - Phone:970-884-2479
Mailing Address - Fax:
Practice Address - Street 1:649 COUNTY ROAD 515
Practice Address - Street 2:
Practice Address - City:IGNACIO
Practice Address - State:CO
Practice Address - Zip Code:81137-9711
Practice Address - Country:US
Practice Address - Phone:970-884-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR16525363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health