Provider Demographics
NPI:1447725403
Name:SWANSON, KERRIN DEANN (CPNP-PC)
Entity type:Individual
Prefix:
First Name:KERRIN
Middle Name:DEANN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-3430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38505 BROOTEN RD
Practice Address - Street 2:
Practice Address - City:PACIFIC CITY
Practice Address - State:OR
Practice Address - Zip Code:97135-8049
Practice Address - Country:US
Practice Address - Phone:503-965-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201810071NP-PP363LP0200X
OR201241786RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse