Provider Demographics
NPI:1609380740
Name:SWANN, CHRISTY REBECCA (BA)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:REBECCA
Last Name:SWANN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5372B OLD VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:URBANNA
Mailing Address - State:VA
Mailing Address - Zip Code:23175-2179
Mailing Address - Country:US
Mailing Address - Phone:804-758-5250
Mailing Address - Fax:804-758-5183
Practice Address - Street 1:5372B OLD VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:URBANNA
Practice Address - State:VA
Practice Address - Zip Code:23175-2179
Practice Address - Country:US
Practice Address - Phone:804-758-5250
Practice Address - Fax:804-758-5183
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator