Provider Demographics
NPI:1558032623
Name:SWANNER, JOEL (PA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:SWANNER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N NAVAJO DR
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-0950
Mailing Address - Country:US
Mailing Address - Phone:928-654-1700
Mailing Address - Fax:
Practice Address - Street 1:440 N NAVAJO DR
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-0950
Practice Address - Country:US
Practice Address - Phone:928-645-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant