Provider Demographics
NPI:1831306562
Name:SWANSON-MOORE, SUSAN D (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:SWANSON-MOORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:S
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-284-1450
Mailing Address - Fax:615-284-1693
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-284-1450
Practice Address - Fax:615-284-1693
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11211364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507493Medicaid
TNP00882584OtherRR MEDICARE
TN1507493Medicaid