Provider Demographics
NPI:1053532382
Name:SWANDER, HEATHER CHRISTINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:SWANDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 COUNTY ROAD 223
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-9703
Mailing Address - Country:US
Mailing Address - Phone:419-307-1686
Mailing Address - Fax:
Practice Address - Street 1:3652 COUNTY ROAD 223
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-9703
Practice Address - Country:US
Practice Address - Phone:419-307-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.119334164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2593724Medicaid