Provider Demographics
NPI:1508919531
Name:SWIFT, DIANE LOUISE (LMP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LOUISE
Last Name:SWIFT
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 1:606 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:RITZVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99169-1930
Mailing Address - Country:US
Mailing Address - Phone:509-660-0585
Mailing Address - Fax:509-659-4422
Practice Address - Street 1:216 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-1410
Practice Address - Country:US
Practice Address - Phone:509-660-0585
Practice Address - Fax:509-659-4422
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018586A122706000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist