MEDICARE: BRENDA L SWANSON ARNP

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	363LP0200X	Pediatric Nurse Practitioner	C065518	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	19775	OTHER	IOWA HEALTH SOLUTIONS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	29743	OTHER	WELLMARK HEALTH PLANS
4	063069	OTHER	HEALTH ALLIANCE
5	IA0157	OTHER	JOHN DEERE HEALTH PLANS

General Provider Information

NPI Number	:	1255337176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA L SWANSON ARNP

Provider Business Mailing Address
First Line	:	3200 WEST KIMBERLY ROAD
Second Line	:	SUITE 100
City	:	DAVENPORT
State	:	IA
Zip	:	52806
Country	:	US
Telephone Number	:	563-355-9191
Fax Number	:	563-355-3419

Provider Business Practice Location Address
First Line	:	1351 W CENTRAL PARK AVE
Second Line	:	STE 4100
City	:	DAVENPORT
State	:	IA
Zip	:	52804-1847
Country	:	US
Telephone Number	:	563-383-2581
Fax Number	:	563-328-5770

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	01/29/2019

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