Provider Demographics
NPI:1659466696
Name:SWARTZENTRUBER, CLEONA MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CLEONA
Middle Name:MARIE
Last Name:SWARTZENTRUBER
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 1:222 N SANGAMON AVE
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936
Mailing Address - Country:US
Mailing Address - Phone:217-784-8148
Mailing Address - Fax:217-784-8160
Practice Address - Street 1:104 S THIRD ST
Practice Address - Street 2:
Practice Address - City:FISHER
Practice Address - State:IL
Practice Address - Zip Code:61843
Practice Address - Country:US
Practice Address - Phone:217-897-1692
Practice Address - Fax:217-897-6027
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse