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 1:265 22 RD
Mailing Address - Street 2:
Mailing Address - City:WILCOX
Mailing Address - State:NE
Mailing Address - Zip Code:68982-3008
Mailing Address - Country:US
Mailing Address - Phone:308-830-9362
Mailing Address - Fax:
Practice Address - Street 1:265 22 RD
Practice Address - Street 2:
Practice Address - City:WILCOX
Practice Address - State:NE
Practice Address - Zip Code:68982-3008
Practice Address - Country:US
Practice Address - Phone:308-830-9362
Practice Address - Fax:308-365-1038
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-117275363LF0000X
CO5654363LF0000X
NE111004363LF0000X, 363LP0808X
TX894367A00000X, 363LF0000X
NE120026367A00000X
IAB-117275367A00000X
CO5670367A00000X
SDCM000043367A00000X
NE56149163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49681010Medicaid