Provider Demographics
NPI:1396168001
Name:SWAN-FIGUEROA, BREANN DANIELLE (APN)
Entity type:Individual
Prefix:MRS
First Name:BREANN
Middle Name:DANIELLE
Last Name:SWAN-FIGUEROA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:BREANN
Other - Middle Name:DANIELLE
Other - Last Name:SWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 S MORRIS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-4884
Mailing Address - Country:US
Mailing Address - Phone:309-808-2778
Mailing Address - Fax:309-808-2965
Practice Address - Street 1:201 W KENYON RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7892
Practice Address - Country:US
Practice Address - Phone:217-531-5365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400189179Medicare PIN