Provider Demographics
NPI:1376716282
Name:SWANSON, JILL RENEE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:RENEE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:RENEE
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8501
Mailing Address - Country:US
Mailing Address - Phone:913-588-3316
Mailing Address - Fax:
Practice Address - Street 1:4000 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-4004
Practice Address - Country:US
Practice Address - Phone:913-588-3316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13-87709-012163W00000X
KS55659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1376716282Medicaid
KSP00621531OtherRR MEDICARE
KS200564310AMedicaid
KSP00621531OtherRR MEDICARE