Provider Demographics
NPI:1639593692
Name:SWANSON, DERICK
Entity Type:Individual
Prefix:
First Name:DERICK
Middle Name:
Last Name:SWANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 BRIDGE ST
Mailing Address - Street 2:APT 94
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-8600
Mailing Address - Country:US
Mailing Address - Phone:530-415-6499
Mailing Address - Fax:
Practice Address - Street 1:1525 BRIDGE ST
Practice Address - Street 2:APT 94
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-8600
Practice Address - Country:US
Practice Address - Phone:530-415-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider