Provider Demographics
NPI:1467231647
Name:SWANSON, JANE CATHLEEN (NP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:CATHLEEN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 AVENIDA MERIDA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3911
Mailing Address - Country:US
Mailing Address - Phone:209-559-2049
Mailing Address - Fax:
Practice Address - Street 1:26933 CAMINO DE ESTRELLA STE A
Practice Address - Street 2:
Practice Address - City:CAPISTRANO BEACH
Practice Address - State:CA
Practice Address - Zip Code:92624-1680
Practice Address - Country:US
Practice Address - Phone:949-493-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027138363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics