Provider Demographics
NPI:1639951031
Name:SWANSON, AFTON KAY (FNP)
Entity Type:Individual
Prefix:
First Name:AFTON
Middle Name:KAY
Last Name:SWANSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AFTON
Other - Middle Name:KAY
Other - Last Name:DEARINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:200 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4689
Mailing Address - Country:US
Mailing Address - Phone:815-933-9660
Mailing Address - Fax:
Practice Address - Street 1:200 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-4689
Practice Address - Country:US
Practice Address - Phone:815-933-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2023085020363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner