Provider Demographics
NPI:1144688243
Name:SWANSON, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PSC 80
Mailing Address - Street 2:BOX 22421
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-9998
Mailing Address - Country:US
Mailing Address - Phone:81909-785-5044
Mailing Address - Fax:
Practice Address - Street 1:PSC 482
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96362-1600
Practice Address - Country:US
Practice Address - Phone:011-819-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006376225100000X
CA41474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist