Basic Information
| Provider Information | |||||||||
| NPI: | 1417395724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | SEPPALA | ||||||||
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| Credential: | ARNP, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 NE GOLDIE ST | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982774832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606795590 | ||||||||
| FaxNumber: | 3606751440 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 NE GOLDIE ST | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982774832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606787656 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2013 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN60128646 | WA | N | Nursing Service Providers | Registered Nurse | 363L00000X | AP60386653 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | AP60386653 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1417395724 | 05 | WA | MEDICAID |