Provider Demographics
NPI:1215246061
Name:SWANSON, NANCY SUE (LMT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 NE 24TH ST
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-5164
Mailing Address - Country:US
Mailing Address - Phone:772-530-1504
Mailing Address - Fax:772-283-0369
Practice Address - Street 1:2565 NE INDIAN RIVER DR
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-5205
Practice Address - Country:US
Practice Address - Phone:772-530-1504
Practice Address - Fax:772-283-0369
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA34598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist