Provider Demographics
NPI:1508803123
Name:SWENSON, KATHERINE ALICE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ALICE
Last Name:SWENSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MO
Mailing Address - Zip Code:65588-0187
Mailing Address - Country:US
Mailing Address - Phone:573-325-4938
Mailing Address - Fax:
Practice Address - Street 1:402 MAIN ST.
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:MO
Practice Address - Zip Code:63965-0486
Practice Address - Country:US
Practice Address - Phone:573-323-4253
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO059092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR22176Medicare UPIN