Provider Demographics
NPI:1417049321
Name:SVINGEN, CAROLYN B (CRNA MS)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:B
Last Name:SVINGEN
Suffix:
Gender:F
Credentials:CRNA MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9898 HART ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8708
Mailing Address - Country:US
Mailing Address - Phone:406-390-0488
Mailing Address - Fax:
Practice Address - Street 1:2000 E LAMAR BLVD
Practice Address - Street 2:SUITE400
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7346
Practice Address - Country:US
Practice Address - Phone:312-909-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN15206367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT237169043594579004OtherTRICARE
MT0355771Medicaid
MT000098650OtherBCBS
MT237169043594579004OtherTRICARE