Provider Demographics
NPI:1073082343
Name:SWANSON, LYNN (APRN)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-4007
Mailing Address - Country:US
Mailing Address - Phone:860-916-9124
Mailing Address - Fax:
Practice Address - Street 1:534 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-4007
Practice Address - Country:US
Practice Address - Phone:860-916-9124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7948363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner