Provider Demographics
NPI:1285871442
Name:SWEMBA, ELLYN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ELLYN
Middle Name:MARIE
Last Name:SWEMBA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:MARIE
Other - Last Name:SWEMBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39500 LIBERTY ST.
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-770-8133
Mailing Address - Fax:510-770-8140
Practice Address - Street 1:39500 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-770-8133
Practice Address - Fax:510-770-8140
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19982364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care