Healthcare Provider Details

I. General information

NPI: 1871179911
Provider Name (Legal Business Name): MICHELLE MARIE SWENSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 08/13/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 550, SPANGDAHLEM AB
APO AE
54529
US

IV. Provider business mailing address

BLDG 550, SPANGDAHLEM AB
APO AE
54529
US

V. Phone/Fax

Practice location:
  • Phone: 315-452-8333
  • Fax:
Mailing address:
  • Phone: 315-452-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022043796
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: