Provider Demographics
NPI:1629540141
Name:SWAIN, DOMINIQUE (PA-C)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:SWAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 MEDICAL CENTER PT STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5765
Mailing Address - Country:US
Mailing Address - Phone:719-634-1994
Mailing Address - Fax:
Practice Address - Street 1:1644 MEDICAL CENTER PT STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5765
Practice Address - Country:US
Practice Address - Phone:719-634-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.000542363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant