Provider Demographics
NPI:1013284595
Name:SWAN, EMMA R (CHP CHA-II)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:R
Last Name:SWAN
Suffix:
Gender:F
Credentials:CHP CHA-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50008
Mailing Address - Street 2:
Mailing Address - City:KIVALINA
Mailing Address - State:AK
Mailing Address - Zip Code:99750-0008
Mailing Address - Country:US
Mailing Address - Phone:907-645-2141
Mailing Address - Fax:907-645-2181
Practice Address - Street 1:8 BERING ST
Practice Address - Street 2:
Practice Address - City:KIVALINA
Practice Address - State:AK
Practice Address - Zip Code:99750
Practice Address - Country:US
Practice Address - Phone:907-645-2141
Practice Address - Fax:907-645-2181
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11-1137-I172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker