Provider Demographics
NPI:1992035216
Name:SWANSTROM, KRISTIN L (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:SWANSTROM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2435 N TRIPHAMMER RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1047
Mailing Address - Country:US
Mailing Address - Phone:607-272-5011
Mailing Address - Fax:607-272-5861
Practice Address - Street 1:2435 N TRIPHAMMER RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1047
Practice Address - Country:US
Practice Address - Phone:607-272-5011
Practice Address - Fax:607-272-5861
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY020545-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant