Healthcare Provider Details

I. General information

NPI: 1174596951
Provider Name (Legal Business Name): ELIZABETH A SWANSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 S MILLENIUM WAY STE 100
MERIDIAN ID
83642-6457
US

IV. Provider business mailing address

1618 S MILLENIUM WAY STE 100
MERIDIAN ID
83642-6457
US

V. Phone/Fax

Practice location:
  • Phone: 208-884-3376
  • Fax: 208-884-0858
Mailing address:
  • Phone: 208-884-3376
  • Fax: 208-884-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberM15214
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number49108
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: