| Doctor Name: | TARA A SWENSON |
| NPI Number: | 1992164354 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 33 336453 |
| Business Practice Address: | 90 Robinson Drive Wallkill, NY - 12589 |
| Business Phone Number: | 8458957156 |
| Business Fax Number: | 8458957173 |
| Mailing Address: | 90 Robinson Drive, WALLKILL |
| State: | NY |
| Postal Code: | 12589 |
| Phone Number: | 8458957156 |
| Fax Number: | 8458957173 |
| NPI Enumeration Date: | 02/15/2016 |
| NPI Last Update Date: | 02/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 33 336453 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |