Basic Information
| Provider Information | |||||||||
| NPI: | 1013284595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWAN | ||||||||
| FirstName: | EMMA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CHP CHA-II | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50008 | ||||||||
| Address2: | |||||||||
| City: | KIVALINA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997500008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9076452141 | ||||||||
| FaxNumber: | 9076452181 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 BERING ST | ||||||||
| Address2: | |||||||||
| City: | KIVALINA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9076452141 | ||||||||
| FaxNumber: | 9076452181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2011 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | 11-1137-I | AK | Y | Other Service Providers | Community Health Worker |
No ID Information.