Provider Demographics
NPI:1457655482
Name:SWANSON, JULIE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-579-3270
Mailing Address - Fax:702-667-4651
Practice Address - Street 1:2316 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2149
Practice Address - Country:US
Practice Address - Phone:702-877-8600
Practice Address - Fax:702-667-4651
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT12489207Q00000X
NV10701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1457655482OtherSMA MEDICAID
NVV111463OtherSMA MEDICARE
CAG56590Medicare UPIN