Provider Demographics
NPI:1629395819
Name:SWANSON, ELIZABETH A (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:SWANSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:736 E 6TH ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-4306
Mailing Address - Country:US
Mailing Address - Phone:617-291-6624
Mailing Address - Fax:
Practice Address - Street 1:8 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1030
Practice Address - Country:US
Practice Address - Phone:508-350-2350
Practice Address - Fax:508-350-2318
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA252488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2132401Medicaid
MAJ41320OtherBC/BS
MA495778OtherTUFTS
MA495778OtherTUFTS