Provider Demographics
NPI:1407583776
Name:SWANN, HEATHER LEANNE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEANNE
Last Name:SWANN
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 1:1187 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1201
Mailing Address - Country:US
Mailing Address - Phone:801-944-3187
Mailing Address - Fax:801-944-3180
Practice Address - Street 1:620 MEDICAL DR STE 205
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5173
Practice Address - Country:US
Practice Address - Phone:801-298-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13623379-1206363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant