Provider Demographics
NPI:1225226269
Name:SWAN, SHARON RUTH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:RUTH
Last Name:SWAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6818
Mailing Address - Country:US
Mailing Address - Phone:815-477-7211
Mailing Address - Fax:
Practice Address - Street 1:440 S MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7147
Practice Address - Country:US
Practice Address - Phone:815-356-8773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse