Provider Demographics
NPI:1063948453
Name:SWENSON, STEPHANIE (MSN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SWENSON
Suffix:
Gender:F
Credentials:MSN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 STEINER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-3903
Mailing Address - Country:US
Mailing Address - Phone:650-391-7887
Mailing Address - Fax:
Practice Address - Street 1:2730 WILSHIRE BLVD STE 425
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4747
Practice Address - Country:US
Practice Address - Phone:949-694-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006432363LP0200X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty