Basic Information
Provider Information | |||||||||
NPI: | 1831754753 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SWANSON | ||||||||
FirstName: | LAURA | ||||||||
MiddleName: | JEAN | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PLOWMAN | ||||||||
OtherFirstName: | LAURA | ||||||||
OtherMiddleName: | JEAN | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 11144 S GOLDEN ASPEN DR | ||||||||
Address2: |   | ||||||||
City: | VAIL | ||||||||
State: | AZ | ||||||||
PostalCode: | 85641 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9078882445 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1717 W COWLES ST | ||||||||
Address2: |   | ||||||||
City: | FAIRBANKS | ||||||||
State: | AK | ||||||||
PostalCode: | 99701 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9074516682 | ||||||||
FaxNumber: | 9073783920 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/06/2019 | ||||||||
LastUpdateDate: | 06/17/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/17/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | NURR36958 | AK | Y |   | Nursing Service Providers | Registered Nurse |   |
No ID Information.