Provider Demographics
NPI:1386792422
Name:SWANSON, JIL K (PA-C)
Entity type:Individual
Prefix:
First Name:JIL
Middle Name:K
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N WREN DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1248
Mailing Address - Country:US
Mailing Address - Phone:412-429-2570
Mailing Address - Fax:412-429-2010
Practice Address - Street 1:95 W BEAU ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-6800
Practice Address - Country:US
Practice Address - Phone:724-228-7006
Practice Address - Fax:724-228-8822
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050752363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P57486Medicare UPIN