Provider Demographics
NPI:1104461870
Name:SWANSON FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:SWANSON FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:217-552-6687
Mailing Address - Street 1:1836 COUNTY ROAD 1250 N
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-9514
Mailing Address - Country:US
Mailing Address - Phone:217-552-6687
Mailing Address - Fax:
Practice Address - Street 1:733 N LOGAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4378
Practice Address - Country:US
Practice Address - Phone:217-552-6687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWANSON FAMILY PRACTICE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-16
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty