Provider Demographics
NPI:1689168825
Name:SWIER, JASMINE ELIZABETH (RDN)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ELIZABETH
Last Name:SWIER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:ELIZABETH
Other - Last Name:GINGRAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1813
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-0935
Practice Address - Fax:602-933-2471
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ402698Medicaid