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General NPI Number Information
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NPI Number | 1376704445
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Entity Type | Individual
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Provider Name | AMANDA ERIN BRISTOL SWANSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/21/2008
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 1102 SOUTH I STREET DOWNTOWN CLINIC - COMMUNITY HEALTH CARE
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City | TACOMA
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State | WA
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Zip | 98405
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Country | US
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Telephone | 253-597-3813
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Fax | 253-597-3815
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Provider Business Mailing Address
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Address Line | 1019 PACIFIC AVENUE STE. 300
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City | TACOMA
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State | WA
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Zip | 98402-4488
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Country | US
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Telephone | 253-722-1540
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60213498
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License Number State | WA
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