Provider Demographics
NPI:1639926074
Name:SWANSON, JULIE KATHERINE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:KATHERINE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:KATHERINE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3599 BIG RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1709
Mailing Address - Country:US
Mailing Address - Phone:585-352-2400
Mailing Address - Fax:585-617-2666
Practice Address - Street 1:3599 BIG RIDGE RD
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1709
Practice Address - Country:US
Practice Address - Phone:585-352-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY846266163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse