Provider Demographics
NPI:1043776727
Name:SWANSON, DONIELLE KAY (CNP)
Entity Type:Individual
Prefix:
First Name:DONIELLE
Middle Name:KAY
Last Name:SWANSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HWY 65 NORTH
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601
Mailing Address - Country:US
Mailing Address - Phone:870-414-4022
Mailing Address - Fax:870-414-2023
Practice Address - Street 1:1401 HWY 65 NORTH
Practice Address - Street 2:SUITE 110
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:704-144-0228
Practice Address - Fax:870-414-4023
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018044680363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics