MEDICARE: MRS. DIANA SWANSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71000013A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417907072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA SWANSON NP

Provider Business Mailing Address
First Line	:	PO BOX 1329
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47402-1329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 WILLOW ST
Second Line	:
City	:	NASHVILLE
State	:	IN
Zip	:	47448-7604
Country	:	US
Telephone Number	:	812-988-2231
Fax Number	:	812-988-2232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	12/23/2020

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