Provider Demographics
NPI:1538776836
Name:SWANK, TERESA L
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:SWANK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 STAUNTON ST
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-4043
Mailing Address - Country:US
Mailing Address - Phone:937-418-8042
Mailing Address - Fax:
Practice Address - Street 1:131 STAUNTON ST
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4043
Practice Address - Country:US
Practice Address - Phone:937-418-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide