Provider Demographics
NPI:1366726689
Name:SWANSON, VICKI LEE (BS, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LEE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:MISS
Other - First Name:VICKI
Other - Middle Name:LEE
Other - Last Name:HOESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 22 RD
Mailing Address - Street 2:
Mailing Address - City:WILCOX
Mailing Address - State:NE
Mailing Address - Zip Code:68982-3008
Mailing Address - Country:US
Mailing Address - Phone:308-478-5532
Mailing Address - Fax:308-478-5810
Practice Address - Street 1:265 22 RD
Practice Address - Street 2:
Practice Address - City:WILCOX
Practice Address - State:NE
Practice Address - Zip Code:68982-3008
Practice Address - Country:US
Practice Address - Phone:308-478-5532
Practice Address - Fax:308-478-5810
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA19412167OtherIBCLC (INTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT)
VA19412167OtherIBCLC (INTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT)