Provider Demographics
NPI:1821367913
Name:SWAN, KRISTINA JOY (BSN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:JOY
Last Name:SWAN
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ORANGE TREE CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3345
Mailing Address - Country:US
Mailing Address - Phone:585-889-2188
Mailing Address - Fax:585-293-4512
Practice Address - Street 1:3560 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5334
Practice Address - Country:US
Practice Address - Phone:585-889-2188
Practice Address - Fax:585-293-4512
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY389481163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse