Provider Demographics
NPI:1477928174
Name:SWENDSON, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SWENDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SUNNYSIDE AVE
Mailing Address - Street 2:ROOM 104E
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-2924
Mailing Address - Country:US
Mailing Address - Phone:913-426-3734
Mailing Address - Fax:
Practice Address - Street 1:1301 SUNNYSIDE AVE
Practice Address - Street 2:ROOM 104E
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-2924
Practice Address - Country:US
Practice Address - Phone:913-426-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program