Provider Demographics
NPI:1730500562
Name:SWOVERLAND, DEBRA (PA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:SWOVERLAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:SJOQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1225 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2368
Mailing Address - Country:US
Mailing Address - Phone:231-935-0788
Mailing Address - Fax:231-935-0787
Practice Address - Street 1:4025 CHUMS VILLAGE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-6992
Practice Address - Country:US
Practice Address - Phone:810-262-9429
Practice Address - Fax:810-296-2910
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant