Healthcare Provider Details

I. General information

NPI: 1376524009
Provider Name (Legal Business Name): SUSAN M SWIFT APRN, BC, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 CASTLEPLACE DR SUITE 130
INDIANAPOLIS IN
46250-1902
US

IV. Provider business mailing address

3126 E NEW HOPE CEMETERY RD
PERU IN
46970-8627
US

V. Phone/Fax

Practice location:
  • Phone: 317-570-7900
  • Fax: 317-570-2290
Mailing address:
  • Phone: 765-472-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71002027A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: