Provider Demographics
NPI:1811223316
Name:SWALLEY, MILLIE (EMT)
Entity Type:Individual
Prefix:
First Name:MILLIE
Middle Name:
Last Name:SWALLEY
Suffix:
Gender:F
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S VISITING EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:NIOBRARA
Mailing Address - State:NE
Mailing Address - Zip Code:68760-7201
Mailing Address - Country:US
Mailing Address - Phone:402-857-2300
Mailing Address - Fax:
Practice Address - Street 1:110 S VISITING EAGLE ST
Practice Address - Street 2:
Practice Address - City:NIOBRARA
Practice Address - State:NE
Practice Address - Zip Code:68760-7201
Practice Address - Country:US
Practice Address - Phone:402-857-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1445146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1445Medicaid