Provider Demographics
NPI:1053612507
Name:SWANSON, STEPHANIE CATHERINE (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CATHERINE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:401 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3628
Mailing Address - Country:US
Mailing Address - Phone:603-668-4111
Mailing Address - Fax:603-628-7757
Practice Address - Street 1:401 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3628
Practice Address - Country:US
Practice Address - Phone:603-668-4111
Practice Address - Fax:603-628-7757
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH063007-21163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health