Provider Demographics
NPI:1477262400
Name:SWINT, BREANNA ALINE
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:ALINE
Last Name:SWINT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 E 2ND ST APT 4
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1655
Mailing Address - Country:US
Mailing Address - Phone:530-713-0344
Mailing Address - Fax:
Practice Address - Street 1:1529 E 2ND ST APT 4
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1655
Practice Address - Country:US
Practice Address - Phone:530-713-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program