Provider Demographics
NPI:1790245678
Name:SWAIN, SUZANNE MICHELLE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:SWAIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 W 94TH TER STE 200
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2536
Mailing Address - Country:US
Mailing Address - Phone:480-729-1205
Mailing Address - Fax:913-677-2112
Practice Address - Street 1:5300 W 94TH TER STE 200
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2536
Practice Address - Country:US
Practice Address - Phone:480-729-1205
Practice Address - Fax:913-677-2112
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225874363LP0808X
KS53-83585-082363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health