Provider Demographics
NPI:1932319324
Name:SWECKER, CRYSTAL ELAINE (PA)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:ELAINE
Last Name:SWECKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BOUNDARY STREET
Mailing Address - Street 2:APT 8
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241
Mailing Address - Country:US
Mailing Address - Phone:304-637-0663
Mailing Address - Fax:
Practice Address - Street 1:#1 MEDICAL CENTER DRIVE
Practice Address - Street 2:LOUIS A. JOHNSON VAMC
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:63014
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant