Provider Demographics
NPI:1780686501
Name:SWANSON, HEATHER SUZETTE (DNP, CNM, FNP, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:SUZETTE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DNP, CNM, FNP, PMHNP
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 343
Mailing Address - Street 2:
Mailing Address - City:LONG PINE
Mailing Address - State:NE
Mailing Address - Zip Code:69217-0343
Mailing Address - Country:US
Mailing Address - Phone:308-830-9362
Mailing Address - Fax:
Practice Address - Street 1:5819 N FM 88
Practice Address - Street 2:HOLY FAMILY SERVICES
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-2275
Practice Address - Country:US
Practice Address - Phone:956-969-2538
Practice Address - Fax:956-969-5884
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE56149163WL0100X
TX894363LF0000X, 367A00000X
IAA-117275363LF0000X
CO5654363LF0000X
NE111004363LP0808X, 363LF0000X
NE120026367A00000X
IAB-117275367A00000X
CO5670367A00000X
SDCM000043367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49681010Medicaid