Provider Demographics
NPI:1710362710
Name:SWENSON, ANDREW P (PA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:SWENSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-3500
Mailing Address - Fax:208-302-3555
Practice Address - Street 1:6165 W EMERALD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-302-3500
Practice Address - Fax:208-302-3555
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363AS0400X
IDPA-1477363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical