Provider Demographics
NPI:1972509826
Name:SWANEY, JEAN M (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:M
Last Name:SWANEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 WILLIAMSBURG WAY NE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8781
Mailing Address - Country:US
Mailing Address - Phone:330-875-3366
Mailing Address - Fax:330-875-1106
Practice Address - Street 1:1917 WILLIAMSBURG WAY NE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-8781
Practice Address - Country:US
Practice Address - Phone:330-875-3366
Practice Address - Fax:330-875-1106
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN142804363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSWNP01472OtherMEDICARE PTAN
OH2020833Medicaid
OHSWNP01472OtherMEDICARE PTAN