Healthcare Provider Details

I. General information

NPI: 1396589073
Provider Name (Legal Business Name): GRACE SWANSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 N HWY 89
CHINO VALLEY AZ
86323-5993
US

IV. Provider business mailing address

2410 N HOPI LN
CHINO VALLEY AZ
86323-8619
US

V. Phone/Fax

Practice location:
  • Phone: 928-636-5680
  • Fax: 928-636-5853
Mailing address:
  • Phone: 928-642-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number309328
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: