Provider Demographics
NPI:1811298003
Name:SWANSEN, LISA ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SWANSEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:8565 S EASTERN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2906
Mailing Address - Country:US
Mailing Address - Phone:888-709-8721
Mailing Address - Fax:855-916-1766
Practice Address - Street 1:8565 S EASTERN AVE STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2906
Practice Address - Country:US
Practice Address - Phone:888-709-8721
Practice Address - Fax:855-916-1766
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAPN 3856363LF0000X
AZRN139100363LF0000X
NVAPRN002782363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ580849Medicaid