1518121359 NPI number — KRISTINA ELLEN CRESSA SWANSON PMHNP

Table of content: KRISTINA ELLEN CRESSA SWANSON PMHNP (NPI 1518121359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518121359 NPI number — KRISTINA ELLEN CRESSA SWANSON PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWANSON
Provider First Name:
KRISTINA
Provider Middle Name:
ELLEN CRESSA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518121359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10001 SE SUNNYSIDE RD
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
CLACKAMAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97015-5746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-653-5205
Provider Business Mailing Address Fax Number:
503-653-5219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10001 SE SUNNYSIDE RD
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-5746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-653-5205
Provider Business Practice Location Address Fax Number:
503-653-5219
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  200850078NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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