Provider Demographics
NPI:1851567762
Name:SWOBODA, LONDA Y (FNP, BSN, MSN)
Entity Type:Individual
Prefix:
First Name:LONDA
Middle Name:Y
Last Name:SWOBODA
Suffix:
Gender:F
Credentials:FNP, BSN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63361-2550
Mailing Address - Country:US
Mailing Address - Phone:573-564-3214
Mailing Address - Fax:573-564-3216
Practice Address - Street 1:111 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CITY
Practice Address - State:MO
Practice Address - Zip Code:63361-2550
Practice Address - Country:US
Practice Address - Phone:573-564-3214
Practice Address - Fax:573-564-3216
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102389363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
263969Medicare Oscar/Certification
000010771Medicare PIN
MOA13279Medicare UPIN