Healthcare Provider Details

I. General information

NPI: 1376711069
Provider Name (Legal Business Name): WILLIAM BREARTON SWENSON RN, PHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 CENTER AVE SUITE 200A
MARTINEZ CA
94553-4640
US

IV. Provider business mailing address

597 CENTER AVE SUITE 200A
MARTINEZ CA
94553-4640
US

V. Phone/Fax

Practice location:
  • Phone: 925-313-6748
  • Fax: 925-313-6465
Mailing address:
  • Phone: 925-313-6748
  • Fax: 925-313-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number402749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: