Provider Demographics
NPI:1689239949
Name:SWANAGAN, ARIEL SADE
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:SADE
Last Name:SWANAGAN
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 1:509 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5907
Mailing Address - Country:US
Mailing Address - Phone:918-913-6881
Mailing Address - Fax:
Practice Address - Street 1:111 S 7TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-7513
Practice Address - Country:US
Practice Address - Phone:918-913-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator