Provider Demographics
NPI:1457871154
Name:SWANBERG, LEONE JOICE
Entity Type:Individual
Prefix:
First Name:LEONE
Middle Name:JOICE
Last Name:SWANBERG
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 1:5329 MCCORDS AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:MI
Mailing Address - Zip Code:49302-9751
Mailing Address - Country:US
Mailing Address - Phone:616-868-6948
Mailing Address - Fax:
Practice Address - Street 1:5329 MCCORDS AVE SE
Practice Address - Street 2:
Practice Address - City:ALTO
Practice Address - State:MI
Practice Address - Zip Code:49302-9751
Practice Address - Country:US
Practice Address - Phone:616-868-6948
Practice Address - Fax:616-868-0129
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health