Provider Demographics
NPI:1417395724
Name:SWAN, ROBERT SEPPALA (ARNP, FNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SEPPALA
Last Name:SWAN
Suffix:
Gender:M
Credentials:ARNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 NE GOLDIE ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-4832
Mailing Address - Country:US
Mailing Address - Phone:360-679-5590
Mailing Address - Fax:360-675-1440
Practice Address - Street 1:1300 NE GOLDIE ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-4832
Practice Address - Country:US
Practice Address - Phone:360-678-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-08
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60128646163W00000X
WAAP60386653363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1417395724Medicaid