Provider Demographics
NPI:1972224442
Name:SWIMM, LOLA FLORENCE (EMT)
Entity Type:Individual
Prefix:
First Name:LOLA
Middle Name:FLORENCE
Last Name:SWIMM
Suffix:
Gender:F
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 BARTRAM FORK RD
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:WV
Mailing Address - Zip Code:25517-7830
Mailing Address - Country:US
Mailing Address - Phone:304-601-1140
Mailing Address - Fax:
Practice Address - Street 1:860 BARTRAM FORK RD
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:WV
Practice Address - Zip Code:25517-7830
Practice Address - Country:US
Practice Address - Phone:304-601-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV082617146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic