Provider Demographics
NPI:1760796619
Name:SWAIN, SHAWNA MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MICHELLE
Last Name:SWAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:MICHELLE
Other - Last Name:CHEZEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:715 SW ANKENY RD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023
Mailing Address - Country:US
Mailing Address - Phone:515-289-9700
Mailing Address - Fax:515-964-3021
Practice Address - Street 1:715 SW ANKENY RD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023
Practice Address - Country:US
Practice Address - Phone:515-289-9700
Practice Address - Fax:515-964-3021
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA578210006OtherMEDICARE PTAN