Healthcare Provider Details

I. General information

NPI: 1902156110
Provider Name (Legal Business Name): ALLYSON PAIGE SWANN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSON PAIGE GRAMSON PA-C

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 S 52ND PL
SPRINGFIELD OR
97478-6210
US

IV. Provider business mailing address

PO BOX 670
BEND OR
97709-0670
US

V. Phone/Fax

Practice location:
  • Phone: 541-746-1166
  • Fax: 541-393-1607
Mailing address:
  • Phone: 541-746-1166
  • Fax: 541-393-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1057
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA173992
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: