Provider Demographics
NPI:1619364312
Name:SWANSON, LATOYA JANAE
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:JANAE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52718 E CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-4607
Mailing Address - Country:US
Mailing Address - Phone:574-315-0299
Mailing Address - Fax:
Practice Address - Street 1:52718 E CYPRESS CIR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-4607
Practice Address - Country:US
Practice Address - Phone:574-315-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other