Provider Demographics
NPI:1689188864
Name:SWANSON, SARA MARIE (MSN, RN, FNP, AANPCB)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MSN, RN, FNP, AANPCB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 COMMONWEALTH BLVD W
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1820
Mailing Address - Country:US
Mailing Address - Phone:127-663-2296
Mailing Address - Fax:127-663-2084
Practice Address - Street 1:287 COMMONWEALTH BLVD W
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1820
Practice Address - Country:US
Practice Address - Phone:127-663-2296
Practice Address - Fax:127-663-2084
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty