Basic Information
| Provider Information | |||||||||
| NPI: | 1043776727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWANSON | ||||||||
| FirstName: | DONIELLE | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 724 N SPRING ST STE A | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726012913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703650850 | ||||||||
| FaxNumber: | 7036508628 | ||||||||
| Practice Location | |||||||||
| Address1: | 724 N SPRING ST STE A | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726012913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036508508 | ||||||||
| FaxNumber: | 8703650862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2019 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 2018044680 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.