Provider Demographics
NPI:1225465305
Name:SWANSON, CHRISTINE (APN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 PUEBLO DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-9238
Mailing Address - Country:US
Mailing Address - Phone:815-271-1733
Mailing Address - Fax:
Practice Address - Street 1:1602 W COLONIAL PKWY UPPR 2
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-1219
Practice Address - Country:US
Practice Address - Phone:847-364-0163
Practice Address - Fax:847-589-5835
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.002391363LF0000X, 363LP0808X
IL209-010662363LF0000X
MECNP231506363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECNP231506OtherNURSE PRACTITIONER LIC# MAINE BOARD