Provider Demographics
NPI:1760675177
Name:SWANSON, LORI LYNN
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LYNN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
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 HH HWY 7775
Mailing Address - Street 2:WINNEBAGO INDIAN HEALTH SERVICE HOSPITAL
Mailing Address - City:WINNEBAGO
Mailing Address - State:NE
Mailing Address - Zip Code:68071-0767
Mailing Address - Country:US
Mailing Address - Phone:402-878-2231
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 77/75
Practice Address - Street 2:WINNEBAGO INDIAN HEALTH SERVICE HOSPITAL
Practice Address - City:WINNEBAGO
Practice Address - State:NE
Practice Address - Zip Code:68071-0767
Practice Address - Country:US
Practice Address - Phone:402-878-2231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-061552363LF0000X
NE110931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily