Healthcare Provider Details

I. General information

NPI: 1376704445
Provider Name (Legal Business Name): AMANDA ERIN BRISTOL SWANSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2008
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 SOUTH I STREET DOWNTOWN CLINIC - COMMUNITY HEALTH CARE
TACOMA WA
98405
US

IV. Provider business mailing address

1019 PACIFIC AVENUE STE. 300
TACOMA WA
98402-4488
US

V. Phone/Fax

Practice location:
  • Phone: 253-597-3813
  • Fax: 253-597-3815
Mailing address:
  • Phone: 253-722-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60213498
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: