Provider Demographics
NPI:1881104438
Name:SWINNY, MONA LISA
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:LISA
Last Name:SWINNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:LISA
Other - Last Name:SWINNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4907 HIGHWAY 84 W
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-3579
Mailing Address - Country:US
Mailing Address - Phone:318-533-0028
Mailing Address - Fax:
Practice Address - Street 1:4907 HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3579
Practice Address - Country:US
Practice Address - Phone:318-414-3065
Practice Address - Fax:318-414-3064
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator