Provider Demographics
NPI:1437216546
Name:SWANSON, KATHRYN EDITH (MSN DCNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:EDITH
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MSN DCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-2593
Mailing Address - Country:US
Mailing Address - Phone:508-765-7711
Mailing Address - Fax:508-765-7713
Practice Address - Street 1:222 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-2593
Practice Address - Country:US
Practice Address - Phone:508-765-7711
Practice Address - Fax:508-765-7713
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA178544363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082580AMedicaid
MASWNP1402Medicare ID - Type Unspecified