Healthcare Provider Details

I. General information

NPI: 1871055319
Provider Name (Legal Business Name): ANNIE RAY DEWITT SWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE DEWITT PA

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COOK ST STE 210
DENVER CO
80206-5328
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 720-516-9402
  • Fax: 720-516-9430
Mailing address:
  • Phone: 970-624-4451
  • Fax: 970-490-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1163545
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0006934
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0006934
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: