Provider Demographics
NPI:1255439741
Name:SWANSON, NANCY ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:SWANSON-WILKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1101 DOVE ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2828
Mailing Address - Country:US
Mailing Address - Phone:949-244-4504
Mailing Address - Fax:949-752-6243
Practice Address - Street 1:1101 DOVE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2828
Practice Address - Country:US
Practice Address - Phone:949-244-4504
Practice Address - Fax:949-752-6243
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP18159Medicare ID - Type Unspecified