MEDICARE: KERRIN DEANN SWANSON CPNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	201810071NP-PP	OR
2	163W00000X	Registered Nurse	201241786RN	OR

General Provider Information

NPI Number	:	1447725403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRIN DEANN SWANSON CPNP-PC

Provider Business Mailing Address
First Line	:	1000 3RD ST
Second Line	:
City	:	TILLAMOOK
State	:	OR
Zip	:	97141-3430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	38505 BROOTEN RD
Second Line	:
City	:	PACIFIC CITY
State	:	OR
Zip	:	97135-8049
Country	:	US
Telephone Number	:	503-965-6555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2018
Last Update Date	:	11/06/2018

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