Provider Demographics
NPI:1992020531
Name:SWAL, JOAN MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:MARIE
Last Name:SWAL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 BERRY GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH SHORE
Mailing Address - State:KY
Mailing Address - Zip Code:41175-8718
Mailing Address - Country:US
Mailing Address - Phone:606-932-9517
Mailing Address - Fax:
Practice Address - Street 1:289 BERRY GARDEN LN
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175-8718
Practice Address - Country:US
Practice Address - Phone:606-932-9517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131255164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse