Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 003762 | CT |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 003762 | CT |
NPI | 1043321540 |
---|---|
Provider Name | Ms. Amanda Marie Swan |
First Address | Wethersfield, CT 06109-1209 |
Second Address | Glastonbury, CT 06033-4205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
363LW0102X | (05) | CT |