Provider Demographics
NPI:1871240879
Name:SWANS, DEWAYNE C
Entity type:Individual
Prefix:
First Name:DEWAYNE
Middle Name:C
Last Name:SWANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:COVERT
Mailing Address - State:MI
Mailing Address - Zip Code:49043-0184
Mailing Address - Country:US
Mailing Address - Phone:269-767-2867
Mailing Address - Fax:
Practice Address - Street 1:73664 26TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-8795
Practice Address - Country:US
Practice Address - Phone:269-767-2867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications