MEDICARE: CANDICE SWANSON PA-C

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	363A00000X	Physician Assistant	6385	AZ

General Provider Information

NPI Number	:	1730532060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE SWANSON PA-C

Provider Business Mailing Address
First Line	:	1531 E UTOPIA RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-3623
Country	:	US
Telephone Number	:	480-286-0694
Fax Number	:

Provider Business Practice Location Address
First Line	:	8101 N 19TH AVE STE A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5161
Country	:	US
Telephone Number	:	602-845-4505
Fax Number	:

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

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	07/21/2016

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Directions to “ CANDICE SWANSON PA-C” Practice Location

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