Provider Demographics
NPI:1679883128
Name:SWANSON, LAURA KRISTINA (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KRISTINA
Last Name:SWANSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33142 CAMAS SWALE RD
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9732
Mailing Address - Country:US
Mailing Address - Phone:541-521-3435
Mailing Address - Fax:
Practice Address - Street 1:3652 WILSHIRE LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-1243
Practice Address - Country:US
Practice Address - Phone:541-521-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201041721RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse