Healthcare Provider Details

I. General information

NPI: 1417379611
Provider Name (Legal Business Name): JILL FRANCES SWANSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 N TELEGRAPH RD
MONROE MI
48162-3368
US

IV. Provider business mailing address

1261 N TELEGRAPH RD
MONROE MI
48162-3368
US

V. Phone/Fax

Practice location:
  • Phone: 734-265-9123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.15307
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.025729
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704357985
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71012906A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCAO-15307-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: