Provider Demographics
NPI:1851187785
Name:SWANSON, DESIREE RENEE (LPN)
Entity type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:RENEE
Last Name:SWANSON
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8427 COUNTRY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1883
Mailing Address - Country:US
Mailing Address - Phone:463-320-1619
Mailing Address - Fax:
Practice Address - Street 1:3140 ARUNDEL LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1815
Practice Address - Country:US
Practice Address - Phone:463-320-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27081757C164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse