Provider Demographics
NPI:1780162172
Name:SWANSON, TAMU (FNP-C)
Entity type:Individual
Prefix:
First Name:TAMU
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W GRAND AVE STE 3003
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4722
Mailing Address - Country:US
Mailing Address - Phone:937-294-3603
Mailing Address - Fax:937-294-3612
Practice Address - Street 1:4172 INDIAN RIPPLE RD
Practice Address - Street 2:STE A
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3286
Practice Address - Country:US
Practice Address - Phone:937-431-3779
Practice Address - Fax:937-431-3776
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0312942Medicaid