Provider Demographics
NPI:1538440805
Name:SWAN, DONNA (LPN)
Entity type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:
Last Name:SWAN
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 1:153 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5373
Mailing Address - Country:US
Mailing Address - Phone:631-234-5289
Mailing Address - Fax:
Practice Address - Street 1:153 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5373
Practice Address - Country:US
Practice Address - Phone:631-234-5289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294288164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse