Provider Demographics
NPI:1457631491
Name:SWANSON, JENNIFER LANE (CD(DONA))
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LANE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17205 WESLEY CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-1205
Mailing Address - Country:US
Mailing Address - Phone:443-739-1241
Mailing Address - Fax:
Practice Address - Street 1:17205 WESLEY CHAPEL RD
Practice Address - Street 2:
Practice Address - City:MONKTON
Practice Address - State:MD
Practice Address - Zip Code:21111-1205
Practice Address - Country:US
Practice Address - Phone:443-739-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula