Provider Demographics
NPI:1174970925
Name:SWANSON, SHEL (CNM)
Entity type:Individual
Prefix:
First Name:SHEL
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SHEL
Other - Middle Name:
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:154 ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2002
Mailing Address - Country:US
Mailing Address - Phone:203-641-2111
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1806
Practice Address - Country:US
Practice Address - Phone:860-525-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000228367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife