Individual
MR. NICKALAUS PHILLIP SWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104
(972) 281-7071
Mailing address
3804 ROCK BLUFF DR, DALLAS, TX 75227-5661
(972) 281-7071
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP137514
TX
Other
Enumeration date
06/19/2017
Last updated
08/30/2018
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