Provider Demographics
NPI:1346617057
Name:SWAIN, KATHRYN S (RN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:SWAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:S
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:617 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-3213
Mailing Address - Country:US
Mailing Address - Phone:618-410-6917
Mailing Address - Fax:
Practice Address - Street 1:617 W CLAY ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-3213
Practice Address - Country:US
Practice Address - Phone:618-410-6917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008022811163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse