Provider Demographics
NPI:1144869546
Name:SWAIN, JARED W (PA-S)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:W
Last Name:SWAIN
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KIMBALL ST APT 20
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1736
Mailing Address - Country:US
Mailing Address - Phone:219-898-9313
Mailing Address - Fax:
Practice Address - Street 1:7 KIMBALL ST APT 20
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1736
Practice Address - Country:US
Practice Address - Phone:219-898-9313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant