Provider Demographics
NPI:1669794707
Name:SWENSKI, JENNIFER MARIE
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARIE
Last Name:SWENSKI
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 1:748 QUINCY AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1739
Mailing Address - Country:US
Mailing Address - Phone:570-961-0851
Mailing Address - Fax:570-344-4285
Practice Address - Street 1:748 QUINCY AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1739
Practice Address - Country:US
Practice Address - Phone:570-961-0851
Practice Address - Fax:570-344-4285
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016914207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029403390001Medicaid
PA1029403390002Medicaid
PA1029403390002Medicaid