Provider Demographics
NPI:1306529458
Name:SWANSON, SARAH JEAN (LM)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:SWANSON-DEXEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM
Mailing Address - Street 1:501 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1525
Mailing Address - Country:US
Mailing Address - Phone:831-252-0644
Mailing Address - Fax:
Practice Address - Street 1:501 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1525
Practice Address - Country:US
Practice Address - Phone:831-252-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA716176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife