Provider Demographics
NPI:1578697850
Name:SWINYER, PAULA M (CNS)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:SWINYER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 6002
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61803-6002
Mailing Address - Country:US
Mailing Address - Phone:217-326-8300
Mailing Address - Fax:
Practice Address - Street 1:1818 E. WINDSOR ROAD
Practice Address - Street 2:ADULT MEDICINE/GERIATRICS
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802
Practice Address - Country:US
Practice Address - Phone:217-369-3550
Practice Address - Fax:217-383-4681
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001149364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6447860006Medicare NSC
ILK10884Medicare ID - Type Unspecified
ILIL3270378Medicare PIN
S71288Medicare UPIN
ILS71288Medicare UPIN