Provider Demographics
NPI:1205918018
Name:SWIHART, SUZONNE S (RN NP)
Entity type:Individual
Prefix:
First Name:SUZONNE
Middle Name:S
Last Name:SWIHART
Suffix:
Gender:F
Credentials:RN NP
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 499
Mailing Address - Street 2:1001 NORTH MAIN AVENUE
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-0499
Mailing Address - Country:US
Mailing Address - Phone:423-743-9176
Mailing Address - Fax:423-743-0860
Practice Address - Street 1:1001 NORTH MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-0499
Practice Address - Country:US
Practice Address - Phone:423-743-9176
Practice Address - Fax:423-743-0860
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000110053363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
3903487Medicare ID - Type Unspecified
S84159Medicare UPIN