Individual
SANNE F VAN SWOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
211 SUDDERTH DR, RUIDOSO, NM 88345-6002
(575) 257-8200
(575) 630-4233
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2019-0073
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
59073268
—
NM
Enumeration date
10/01/2019
Last updated
02/18/2022
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