Provider Demographics
NPI:1639838139
Name:SWART, RENEE DAWN
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DAWN
Last Name:SWART
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 1:10820 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8630
Mailing Address - Country:US
Mailing Address - Phone:219-351-5217
Mailing Address - Fax:219-351-5356
Practice Address - Street 1:10820 PARK PL
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8630
Practice Address - Country:US
Practice Address - Phone:219-351-5217
Practice Address - Fax:219-351-5356
Is Sole Proprietor?:No
Enumeration Date:2021-12-12
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27051497C164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse