Provider Demographics
NPI:1700976875
Name:SWANN, BRENDA JANINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JANINE
Last Name:SWANN
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:PO BOX 247
Mailing Address - Street 2:31899 CARPENTER RD.
Mailing Address - City:LYMAN
Mailing Address - State:WA
Mailing Address - Zip Code:98263-0047
Mailing Address - Country:US
Mailing Address - Phone:360-929-6201
Mailing Address - Fax:
Practice Address - Street 1:7825 N SOUND DR
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-7675
Practice Address - Country:US
Practice Address - Phone:800-903-7952
Practice Address - Fax:425-349-8544
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00046878101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALP00046878OtherNURSING LICENSE