Provider Demographics
NPI:1659360634
Name:SWALLIE, LINDA SUZANNA (CRNP, MSN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUZANNA
Last Name:SWALLIE
Suffix:
Gender:F
Credentials:CRNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56195 SOMERTON HWY
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-9550
Mailing Address - Country:US
Mailing Address - Phone:740-757-2513
Mailing Address - Fax:740-432-3053
Practice Address - Street 1:61353 SOUTHGATE RD
Practice Address - Street 2:SUITE #6
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-6607
Practice Address - Country:US
Practice Address - Phone:740-432-3434
Practice Address - Fax:740-432-3053
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06907363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341344Medicaid
OH2341344Medicaid