Healthcare Provider Details

I. General information

NPI: 1033042429
Provider Name (Legal Business Name): CLARA LEISTER SWANSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE JOINT BASE LEWIS-MCCHORD
TACOMA WA
98431-0001
US

IV. Provider business mailing address

25 MEADOWVIEW LN
HARTLAND VT
05048-9445
US

V. Phone/Fax

Practice location:
  • Phone: 802-356-5336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP.AP.70143841
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: