Provider Demographics
NPI:1760638373
Name:SCHWAN, NICOLE ALEXANDRIA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ALEXANDRIA
Last Name:SCHWAN
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 1:1872 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55055-1032
Mailing Address - Country:US
Mailing Address - Phone:612-209-8261
Mailing Address - Fax:
Practice Address - Street 1:1872 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:MN
Practice Address - Zip Code:55055-1032
Practice Address - Country:US
Practice Address - Phone:612-209-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL-063492-6164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse