Provider Demographics
NPI:1194326967
Name:SWANSON, SARA (NP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MAIN ST
Mailing Address - Street 2:STE 110 - CARDIOLOGY
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-7077
Mailing Address - Country:US
Mailing Address - Phone:167-832-3207
Mailing Address - Fax:716-484-2582
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:STE 110 - CARDIOLOGY
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-7077
Practice Address - Country:US
Practice Address - Phone:167-832-3207
Practice Address - Fax:716-484-2582
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346090-01363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner