Provider Demographics
NPI:1124044144
Name:ALEXANDER SWANK, DENISE (NP)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:ALEXANDER SWANK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:G
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:75-306 GERALD FORD DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2591
Mailing Address - Country:US
Mailing Address - Phone:760-834-2500
Mailing Address - Fax:
Practice Address - Street 1:75036 GERALD FORD DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-2080
Practice Address - Country:US
Practice Address - Phone:760-834-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388052363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15793ZMedicare ID - Type Unspecified