Provider Demographics
NPI:1669713319
Name:SWENSON, REBECCA SHAWN (FNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SHAWN
Last Name:SWENSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4777 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-7439
Mailing Address - Country:US
Mailing Address - Phone:262-605-5854
Mailing Address - Fax:262-605-5903
Practice Address - Street 1:4777 88TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-7439
Practice Address - Country:US
Practice Address - Phone:262-605-5854
Practice Address - Fax:262-605-5903
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5033-33363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily