Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | C-APN.0002819-C-NP | CO |
NPI | 1003498403 |
---|---|
Provider Name | Kelsey Lee Swanson |
First Address | Las Vegas, NV 89135-1674 |
Second Address | Denver, CO 80220-1231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2021 |
Last Update Date | 25/04/2021 |