Provider Demographics
NPI:1669133435
Name:DUTTA, SWAPNA (FNP)
Entity type:Individual
Prefix:
First Name:SWAPNA
Middle Name:
Last Name:DUTTA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 W AUBURN CREST CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-8535
Mailing Address - Country:US
Mailing Address - Phone:509-688-9687
Mailing Address - Fax:
Practice Address - Street 1:6811 S 204TH ST STE 280
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1352
Practice Address - Country:US
Practice Address - Phone:888-674-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61247831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily