Basic Information
| Provider Information | |||||||||
| NPI: | 1578906715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWAN | ||||||||
| FirstName: | JESSIE | ||||||||
| MiddleName: | ALEXANDRA | ||||||||
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| OtherLastName: | SWAN | ||||||||
| OtherFirstName: | JESSIE | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | P.O. BOX 172328 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802172328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033067783 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Practice Location | |||||||||
| Address1: | 9191 GRANT STREET | ||||||||
| Address2: | |||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802298812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034504482 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2013 | ||||||||
| LastUpdateDate: | 09/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | DR.0057085 | CO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.