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Individual

BLANCHE MYRTLE SWANSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
818 LAKE ST, KOTZEBUE, AK 99752
(907) 442-7730
(907) 442-4375
Mailing address
PO BOX 256, KOTZEBUE, AK 99752-0256
(907) 442-7730
(907) 442-4375

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
92-0041461
AK
Enumeration date
04/04/2018
Last updated
06/16/2018
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