Provider Demographics
NPI:1205232667
Name:SWONGER, LYNN
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:SWONGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-9478
Mailing Address - Country:US
Mailing Address - Phone:330-369-4672
Mailing Address - Fax:
Practice Address - Street 1:3427 MILEAR RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9478
Practice Address - Country:US
Practice Address - Phone:330-469-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06689314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility