Provider Demographics
NPI:1588860563
Name:SWANSON, MONA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
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:PO BOX 2608
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01101
Mailing Address - Country:US
Mailing Address - Phone:413-599-4994
Mailing Address - Fax:413-599-4969
Practice Address - Street 1:2141 BOSTON RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095
Practice Address - Country:US
Practice Address - Phone:413-599-4994
Practice Address - Fax:413-599-4969
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209973207L00000X
MARN209973367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA0878Medicare ID - Type Unspecified