Individual
MS. CAROLYN DIANE SWAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
417 MAIN ST, JULIAETTA, ID 83535-5003
(208) 276-3174
Mailing address
417 MAIN ST, JULIAETTA, ID 83535-5003
(208) 276-3174
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
CFH20165
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807843600
—
ID
Enumeration date
06/06/2008
Last updated
06/06/2008
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