Provider Demographics
NPI:1508816083
Name:SWANSON, TARA L (NP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:SWANSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:NE
Mailing Address - Zip Code:68714-0146
Mailing Address - Country:US
Mailing Address - Phone:402-684-2285
Mailing Address - Fax:402-684-2299
Practice Address - Street 1:101 E SOUTH STREET
Practice Address - Street 2:
Practice Address - City:BASSETT
Practice Address - State:NE
Practice Address - Zip Code:68714
Practice Address - Country:US
Practice Address - Phone:402-684-2285
Practice Address - Fax:402-684-2299
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110733363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE246575OtherMIDLANDS CHOICE
NE507046435Medicaid
NE39169OtherBCBS
NE246575OtherMIDLANDS CHOICE
NE507046435Medicaid