Healthcare Provider Details

I. General information

NPI: 1700868114
Provider Name (Legal Business Name): CAROL MARIE SWENSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2005
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 E BELL RD SUITE 170
PHOENIX AZ
85032-9306
US

IV. Provider business mailing address

4550 E BELL RD SUITE 170
PHOENIX AZ
85032-9306
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-8400
  • Fax: 480-443-8697
Mailing address:
  • Phone: 480-443-8400
  • Fax: 480-443-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP94
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: