Provider Demographics
NPI:1811133168
Name:SWANSON, NINA G (LIMPH, CPC)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:G
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LIMPH, CPC
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 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2315 W 39TH ST
Practice Address - Street 2:BOX 4
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8327
Practice Address - Country:US
Practice Address - Phone:308-237-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE192101Y00000X
NE1105101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1105OtherCPC
NE192OtherLIMPH