Provider Demographics
NPI:1467406751
Name:SWANSON, STEVEN BRUCE (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRUCE
Last Name:SWANSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 S CASCADE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1604
Mailing Address - Country:US
Mailing Address - Phone:719-538-2950
Mailing Address - Fax:719-538-2999
Practice Address - Street 1:715 N WEBER ST STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1092
Practice Address - Country:US
Practice Address - Phone:719-636-3555
Practice Address - Fax:719-667-4230
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172297367500000X
COAPN.0004685-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21128545Medicaid
CO447466ZL1POtherMEDICARE - CO
CO803125Medicare PIN