Provider Demographics
NPI:1700121910
Name:SWANSON, CORAL META (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CORAL
Middle Name:META
Last Name:SWANSON
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 1:405 WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:WI
Mailing Address - Zip Code:53553-9755
Mailing Address - Country:US
Mailing Address - Phone:608-574-9204
Mailing Address - Fax:
Practice Address - Street 1:405 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:WI
Practice Address - Zip Code:53553-9755
Practice Address - Country:US
Practice Address - Phone:608-574-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21847-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse