Healthcare Provider Details

I. General information

NPI: 1508816083
Provider Name (Legal Business Name): TARA L SWANSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/30/2024
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E SOUTH STREET
BASSETT NE
68714
US

IV. Provider business mailing address

PO BOX 377
STUART NE
68780-0377
US

V. Phone/Fax

Practice location:
  • Phone: 402-684-2285
  • Fax: 402-684-2299
Mailing address:
  • Phone: 402-684-2285
  • Fax: 402-684-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110733
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: