Basic Information
| Provider Information | |||||||||
| NPI: | 1245696913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWENSON | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 555 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802010555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014753500 | ||||||||
| FaxNumber: | 8014753489 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 W 2700 N | ||||||||
| Address2: | |||||||||
| City: | PLEASANT VIEW | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844044791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014753600 | ||||||||
| FaxNumber: | 8014753601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2016 | ||||||||
| LastUpdateDate: | 05/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 8171394-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1245696913 | 05 | UT | MEDICAID |