Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MT186402 | PA |
Y | 111NI0900X | Internist | MT186402 | PA |
NPI | 1003029562 |
---|---|
Provider Name | Nicole Swallow |
First Address | Hershey, PA 17033-2360 |
Second Address | Hershey, PA 17033-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |