Provider Demographics
NPI:1831820067
Name:SWANSON, KIMBERLEE JEAN (BSN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:JEAN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:MS
Other - First Name:KIMBERLEE
Other - Middle Name:J
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:117 1/2 VINE ST REAR APT
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4619
Mailing Address - Country:US
Mailing Address - Phone:843-455-7589
Mailing Address - Fax:
Practice Address - Street 1:33 MAIN DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-5099
Practice Address - Country:US
Practice Address - Phone:814-726-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA742505163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse