Provider Demographics
NPI:1215127386
Name:SWANSON, FLORA KAY (RN)
Entity type:Individual
Prefix:MRS
First Name:FLORA
Middle Name:KAY
Last Name:SWANSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-4048
Mailing Address - Country:US
Mailing Address - Phone:845-895-3461
Mailing Address - Fax:
Practice Address - Street 1:1159 PLAINS RD
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-4048
Practice Address - Country:US
Practice Address - Phone:845-895-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304859-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02523260Medicaid