Provider Demographics
NPI:1417164906
Name:SWAVING, ROBERTA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:MARIE
Last Name:SWAVING
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15220 SE 272ND ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4241
Mailing Address - Country:US
Mailing Address - Phone:253-740-3399
Mailing Address - Fax:425-631-7933
Practice Address - Street 1:15220 SE 272ND ST
Practice Address - Street 2:SUITE D
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-4241
Practice Address - Country:US
Practice Address - Phone:253-740-3399
Practice Address - Fax:425-631-7933
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022269174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0218132Medicare UPIN