Healthcare Provider Details

I. General information

NPI: 1962527168
Provider Name (Legal Business Name): DONNA SWANSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 GRANVILLE RD
NORTH GRANBY CT
06060-1303
US

IV. Provider business mailing address

274 GRANVILLE RD
NORTH GRANBY CT
06060-1303
US

V. Phone/Fax

Practice location:
  • Phone: 860-693-8831
  • Fax:
Mailing address:
  • Phone: 860-693-8831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number00812
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: