Provider Demographics
NPI:1306472006
Name:SWANSON, CLARISSA ANGELA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:ANGELA
Last Name:SWANSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:ANGELA
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:58011 HIDDEN GOLD DR
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-6290
Mailing Address - Country:US
Mailing Address - Phone:760-333-6005
Mailing Address - Fax:
Practice Address - Street 1:5770 RIVERSIDE DR BLDG 601
Practice Address - Street 2:
Practice Address - City:MARCH ARB
Practice Address - State:CA
Practice Address - Zip Code:92518-1838
Practice Address - Country:US
Practice Address - Phone:951-655-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA785953163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse