Provider Demographics
NPI:1669466033
Name:SWANSON, ELIZABETH O (APRN-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:O
Last Name:SWANSON
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4815
Mailing Address - Country:US
Mailing Address - Phone:864-235-2335
Mailing Address - Fax:864-877-1260
Practice Address - Street 1:2700 E PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4815
Practice Address - Country:US
Practice Address - Phone:864-235-2335
Practice Address - Fax:864-877-1260
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF930363L00000X, 364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA394338110ABMedicaid
GA394338110ABMedicaid