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General NPI Number Information
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NPI Number | 1316778087
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Entity Type | Individual
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Provider Name | PHILLIP JAMES SWANSON
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Gender | Male
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 15813 PAUL VEGA MD DR STE 401A
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City | HAMMOND
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State | LA
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Zip | 70403-1426
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Country | US
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Telephone | 985-230-1580
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Fax | 985-230-1585
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Provider Business Mailing Address
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Address Line | 39715 S HOOVER RD APT A
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City | PONCHATOULA
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State | LA
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Zip | 70454-4651
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Country | US
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Telephone | 662-848-9597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 237082
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License Number State | LA
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