Provider Demographics
NPI:1619963931
Name:SWANSON, STEPHEN GENE (MD FACOG)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GENE
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MD FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LYNCREST DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2229
Mailing Address - Country:US
Mailing Address - Phone:402-434-3370
Mailing Address - Fax:402-489-0731
Practice Address - Street 1:220 LYNCREST DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2229
Practice Address - Country:US
Practice Address - Phone:402-434-3370
Practice Address - Fax:402-489-0731
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12889207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055126013Medicaid
NE47055126013Medicaid
D93267Medicare UPIN