Provider Demographics
NPI:1790481703
Name:SWANN, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SWANN
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 1:6867 DUMBARTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4252
Mailing Address - Country:US
Mailing Address - Phone:980-210-1566
Mailing Address - Fax:
Practice Address - Street 1:6867 DUMBARTON DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4252
Practice Address - Country:US
Practice Address - Phone:980-210-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL-309643163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant