Individual
TINA LORENE SWANKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
147 N STATE ST, BERLIN, WI 54923-1621
(920) 361-3515
Mailing address
N6681 COUNTY RD N, PRINCETON, WI 54968-9323
(920) 229-0955
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
729-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40729700
—
WI
Enumeration date
09/22/2006
Last updated
07/08/2007
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