Provider Demographics
NPI:1023086741
Name:SWALLOW, LINDA JEAN (CRNP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JEAN
Last Name:SWALLOW
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 1:305 HOSPITAL DR
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5805
Mailing Address - Country:US
Mailing Address - Phone:410-552-8154
Mailing Address - Fax:410-553-8134
Practice Address - Street 1:305 HOSPITAL DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5805
Practice Address - Country:US
Practice Address - Phone:410-552-8154
Practice Address - Fax:410-553-8134
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR098213363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD621731100Medicaid
MDS67331Medicare UPIN
MDK986Medicare ID - Type Unspecified