Provider Demographics
NPI:1225432669
Name:SWANK, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:SWANK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 E MIDVALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ENOCH
Mailing Address - State:UT
Mailing Address - Zip Code:84721-7603
Mailing Address - Country:US
Mailing Address - Phone:435-263-0355
Mailing Address - Fax:435-263-0123
Practice Address - Street 1:476 E MIDVALLEY RD
Practice Address - Street 2:
Practice Address - City:ENOCH
Practice Address - State:UT
Practice Address - Zip Code:84721-7603
Practice Address - Country:US
Practice Address - Phone:435-263-0355
Practice Address - Fax:435-263-0123
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1114875OtherNCCPA NUMBER