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General NPI Number Information
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NPI Number | 1104461870
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Entity Type | Organization
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Legal Business Name | SWANSON FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 11/16/2019
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 723 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4384
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Country | US
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Telephone | 217-213-5808
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Fax | 217-213-6290
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Provider Business Mailing Address
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Address Line | 1836 COUNTY ROAD 1250 N
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City | URBANA
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State | IL
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Zip | 61802-9514
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Country | US
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Telephone | 217-552-6687
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DINA G SWANSON
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Credential | FNP
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Telephone | 217-552-6687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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