Healthcare Provider Details

I. General information

NPI: 1235067547
Provider Name (Legal Business Name): DANIELLE MARIE DESIREE SWANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5135 E HART LAKE LOOP
WASILLA AK
99654-9362
US

IV. Provider business mailing address

5135 E HART LAKE LOOP
WASILLA AK
99654-9362
US

V. Phone/Fax

Practice location:
  • Phone: 940-300-5501
  • Fax:
Mailing address:
  • Phone: 940-300-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: