Basic Information
Provider Information | |||||||||
NPI: | 1093717555 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SWIGER | ||||||||
FirstName: | CHRISTA | ||||||||
MiddleName: | HARDY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 124 CENTURY OAK LN | ||||||||
Address2: |   | ||||||||
City: | MANDEVILLE | ||||||||
State: | LA | ||||||||
PostalCode: | 704716436 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9855024104 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1100 ANDRE ST | ||||||||
Address2: | SUITE 300 | ||||||||
City: | NEW IBERIA | ||||||||
State: | LA | ||||||||
PostalCode: | 705632159 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3373649225 | ||||||||
FaxNumber: | 3373646094 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/15/2005 | ||||||||
LastUpdateDate: | 11/21/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN057729 | LA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | 1093717555 | 01 | LA | BCBS LA | OTHER | 1902802 | 05 | LA |   | MEDICAID | P01116364 | 01 | LA | RR MEDICARE | OTHER |