Provider Demographics
NPI:1346678323
Name:SWANSON, MARINA V
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:V
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 SILVER LAKE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9542
Mailing Address - Country:US
Mailing Address - Phone:707-317-7513
Mailing Address - Fax:
Practice Address - Street 1:4823 SILVER LAKE CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9542
Practice Address - Country:US
Practice Address - Phone:707-317-7513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program