Provider Demographics
NPI:1578733853
Name:MCSWIGGAN, LILLIAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:
Last Name:MCSWIGGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MOORE ST APT 13D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-3612
Mailing Address - Country:US
Mailing Address - Phone:347-457-6106
Mailing Address - Fax:
Practice Address - Street 1:130 MOORE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-3636
Practice Address - Country:US
Practice Address - Phone:347-457-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2534041164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02075116Medicaid