Provider Demographics
NPI:1295766897
Name:SWAN, CAROL F (CRNA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:F
Last Name:SWAN
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:S
Other - Last Name:FARPOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 79137
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0137
Mailing Address - Country:US
Mailing Address - Phone:757-668-7200
Mailing Address - Fax:757-668-9691
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7320
Practice Address - Fax:757-668-9735
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024102962367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010098289Medicaid
NC8052152Medicaid
NC8052152Medicaid
VA010098289Medicaid