Provider Demographics
NPI: | 1700882875 |
---|---|
Name: | SWEGLE, JAMES H (ARNP) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | JAMES |
Middle Name: | H |
Last Name: | SWEGLE |
Suffix: | |
Gender: | M |
Credentials: | ARNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1400 E KINCAID ST |
Mailing Address - Street 2: | ATTN: CREDENTIALING |
Mailing Address - City: | MOUNT VERNON |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98274-4127 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 360-428-2500 |
Mailing Address - Fax: | 360-428-6485 |
Practice Address - Street 1: | 208 S. 14TH STREET |
Practice Address - Street 2: | SKAGIT VALLEY HOSPITAL - WOUND HEALING CENTER |
Practice Address - City: | MOUNT VERNON |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98274 |
Practice Address - Country: | US |
Practice Address - Phone: | 360-814-2600 |
Practice Address - Fax: | 360-814-8390 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-23 |
Last Update Date: | 2014-07-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | AP30001783 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | S84223 | Medicare UPIN | |
WA | 8905224 | Medicare PIN | |
WA | 9602418 | Medicaid | |
WA | 73009 | Other | LI |