Provider Demographics
NPI:1902156110
Name:SWANN, ALLYSON PAIGE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:PAIGE
Last Name:SWANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:PAIGE
Other - Last Name:GRAMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0670
Mailing Address - Country:US
Mailing Address - Phone:541-746-1166
Mailing Address - Fax:541-393-1607
Practice Address - Street 1:147 S 52ND PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-6210
Practice Address - Country:US
Practice Address - Phone:541-746-1166
Practice Address - Fax:541-393-1607
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1057363A00000X
ORPA173992363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant