Provider Demographics
NPI:1326296898
Name:SWANK, COLIN PORTER (LPN)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:PORTER
Last Name:SWANK
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 HARRIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9739
Mailing Address - Country:US
Mailing Address - Phone:716-681-5404
Mailing Address - Fax:
Practice Address - Street 1:523 HARRIS HILL RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-9739
Practice Address - Country:US
Practice Address - Phone:716-681-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209143-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse