Provider Demographics
NPI:1962527168
Name:SWANSON, DONNA (APRN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06060-1303
Mailing Address - Country:US
Mailing Address - Phone:860-693-8831
Mailing Address - Fax:
Practice Address - Street 1:274 GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTH GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06060-1303
Practice Address - Country:US
Practice Address - Phone:860-693-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00812363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health