Healthcare Provider Details

I. General information

NPI: 1104461870
Provider Name (Legal Business Name): SWANSON FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2019
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 N LOGAN AVE
DANVILLE IL
61832-4384
US

IV. Provider business mailing address

1836 COUNTY ROAD 1250 N
URBANA IL
61802-9514
US

V. Phone/Fax

Practice location:
  • Phone: 217-213-5808
  • Fax: 217-213-6290
Mailing address:
  • Phone: 217-552-6687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DINA G SWANSON
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 217-552-6687