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General NPI Number Information
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NPI Number | 1669713319
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Entity Type | Individual
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Provider Name | REBECCA SHAWN SWENSON FNP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 4777 88TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-7439
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Country | US
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Telephone | 262-605-5854
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Fax | 262-605-5903
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Provider Business Mailing Address
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Address Line | 4777 88TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-7439
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Country | US
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Telephone | 262-605-5854
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Fax | 262-605-5903
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5033-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5033-33
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License Number State | WI
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