Individual
JACQUELYNN THERESE SWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01064739A
IN
207RN0300X
Nephrology Physician
Primary
01064739A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1100217272
ANTHEM PTAN
IN
05
—
200907780
—
IN
Enumeration date
03/24/2006
Last updated
04/25/2025
Update your record
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