MEDICARE: VICKI JOY SWANSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	200250059NPFNPPP	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200250059NP FNP-PP	OTHER	OR	LICENSE

General Provider Information

NPI Number	:	1710958277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI JOY SWANSON FNP

Provider Business Mailing Address
First Line	:	PO BOX 1189
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97339-1189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 HICKORY ST NW STE 300
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1700
Country	:	US
Telephone Number	:	541-812-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	10/28/2024

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