Provider Demographics
NPI:1962462804
Name:SWAN, JACQUELYNN THERESE (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:THERESE
Last Name:SWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELYNN
Other - Middle Name:THERESE
Other - Last Name:SAAVEDRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5492 N RONALD REAGAN PKWY STE 260
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-5618
Mailing Address - Country:US
Mailing Address - Phone:317-456-9053
Mailing Address - Fax:317-386-5480
Practice Address - Street 1:5492 N RONALD REAGAN PKWY STE 260
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-5618
Practice Address - Country:US
Practice Address - Phone:317-217-2444
Practice Address - Fax:317-217-2449
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064739A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN354590084OtherMEDICARE
IN200907780Medicaid
IN200907780Medicaid
FL07128SMedicare PIN
FL048307900Medicaid