1780704866 NPI number — MS. VIRGINIA LANE SWARTZ APRN-BC,PNP

Table of content: MS. VIRGINIA LANE SWARTZ APRN-BC,PNP (NPI 1780704866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780704866 NPI number — MS. VIRGINIA LANE SWARTZ APRN-BC,PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWARTZ
Provider First Name:
VIRGINIA
Provider Middle Name:
LANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC,PNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780704866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 N OAK AVE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
COOKEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38501-2435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-783-5857
Provider Business Mailing Address Fax Number:
931-526-6760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
COOKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38501-4294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-783-2770
Provider Business Practice Location Address Fax Number:
931-525-1176
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  11902 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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