Provider Demographics
NPI:1760796619
Name:SWAIN, SHAWNA MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MICHELLE
Last Name:SWAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:MICHELLE
Other - Last Name:CHEZEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9100
Mailing Address - Fax:
Practice Address - Street 1:5950 UNIVERSITY AVE STE 105
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7756
Practice Address - Country:US
Practice Address - Phone:515-875-9070
Practice Address - Fax:515-875-9071
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA578210006OtherMEDICARE PTAN