Provider Demographics
NPI:1265267405
Name:CHIBAMBO SWANIGAN, MONASE MICKNESS (NP)
Entity type:Individual
Prefix:DR
First Name:MONASE
Middle Name:MICKNESS
Last Name:CHIBAMBO SWANIGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MONASE
Other - Middle Name:
Other - Last Name:CHIBAMBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3622 NOTTINGHAM DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-1361
Mailing Address - Country:US
Mailing Address - Phone:616-970-9610
Mailing Address - Fax:
Practice Address - Street 1:3622 NOTTINGHAM DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-1361
Practice Address - Country:US
Practice Address - Phone:616-970-9610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704303464363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology