Provider Demographics
NPI:1770062580
Name:SWANSON, DOROTHY BROWN (PA-C)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:BROWN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ROGERS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5745
Mailing Address - Country:US
Mailing Address - Phone:919-385-1601
Mailing Address - Fax:
Practice Address - Street 1:3000 ROGERS RD STE 100
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5745
Practice Address - Country:US
Practice Address - Phone:919-385-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08332363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant