Provider Demographics
NPI:1184052516
Name:SWANSON, DINA (APN)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:GABRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 HEALTH CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4693
Mailing Address - Country:US
Mailing Address - Phone:217-238-6055
Mailing Address - Fax:
Practice Address - Street 1:1100 TUSCOLA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-2065
Practice Address - Country:US
Practice Address - Phone:217-253-2020
Practice Address - Fax:217-253-4886
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010779363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner