Provider Demographics
NPI:1093860470
Name:SWENSON, JUDI A (NP)
Entity Type:Individual
Prefix:MS
First Name:JUDI
Middle Name:A
Last Name:SWENSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JUDI
Other - Middle Name:ANN
Other - Last Name:TASHJIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN/NP
Mailing Address - Street 1:275 W MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5641
Mailing Address - Country:US
Mailing Address - Phone:510-752-1000
Mailing Address - Fax:
Practice Address - Street 1:275 W MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5641
Practice Address - Country:US
Practice Address - Phone:510-752-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA321782363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR001572DMedicaid
CA0345090OtherANCC CERTIFICATION
CA0345090OtherANCC CERTIFICATION