Provider Demographics
NPI:1558008003
Name:SWANN, SUSAN M (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:SWANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65434 HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-5648
Mailing Address - Country:US
Mailing Address - Phone:985-863-5882
Mailing Address - Fax:985-863-7658
Practice Address - Street 1:65434 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-5648
Practice Address - Country:US
Practice Address - Phone:985-863-5882
Practice Address - Fax:985-863-7658
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN081707163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty