Provider Demographics
NPI:1053354035
Name:SWENSON, SHIRLEY J (FNP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:J
Last Name:SWENSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6636
Mailing Address - Country:US
Mailing Address - Phone:716-484-7107
Mailing Address - Fax:716-664-2500
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:SUITE 160
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6636
Practice Address - Country:US
Practice Address - Phone:716-484-7107
Practice Address - Fax:716-664-2500
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF33435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2556958Medicaid
NYJ400168891OtherMEDICARE PTAN
NYQ21292Medicare UPIN