Provider Demographics
NPI:1023673340
Name:DIDONATO-SWINGLE, B J (LPN)
Entity type:Individual
Prefix:
First Name:B J
Middle Name:
Last Name:DIDONATO-SWINGLE
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 1:24 FAITH DR
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-5234
Mailing Address - Country:US
Mailing Address - Phone:845-978-5369
Mailing Address - Fax:
Practice Address - Street 1:24 FAITH DR
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-5234
Practice Address - Country:US
Practice Address - Phone:845-978-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328331-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse