Provider Demographics
NPI:1659609337
Name:SWAN, JUDITH A (RN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:SWAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 PEBBLEBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1258
Mailing Address - Country:US
Mailing Address - Phone:608-825-8103
Mailing Address - Fax:
Practice Address - Street 1:1576 PEBBLEBROOK TRL
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1258
Practice Address - Country:US
Practice Address - Phone:608-825-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69833 030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse