Provider Demographics
NPI:1821783986
Name:SWIFT EAGLE JOHNSON, PARIS JEAN
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:JEAN
Last Name:SWIFT EAGLE JOHNSON
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 1:4255 TAMARUS ST APT 168
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5706
Mailing Address - Country:US
Mailing Address - Phone:725-256-3973
Mailing Address - Fax:
Practice Address - Street 1:4570 S EASTERN AVE STE 21
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6183
Practice Address - Country:US
Practice Address - Phone:702-733-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNA208000000X
NV2106049731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics