Healthcare Provider Details

I. General information

NPI: 1730774969
Provider Name (Legal Business Name): LAUREN SWAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 01/09/2023
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 10TH ST
PERRY IA
50220-2221
US

IV. Provider business mailing address

835 SE PRAIRIE PARK LN
WAUKEE IA
50263-8613
US

V. Phone/Fax

Practice location:
  • Phone: 515-465-3547
  • Fax:
Mailing address:
  • Phone: 319-461-8092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number115801
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: