Healthcare Provider Details

I. General information

NPI: 1225492739
Provider Name (Legal Business Name): BRIELLE JOY SWANSTROM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIELLE JOY HAGGERTY MD

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 30TH AVE W
ALEXANDRIA MN
56308-3426
US

IV. Provider business mailing address

14000 FAIRVIEW DR
BURNSVILLE MN
55337-4571
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-2540
  • Fax:
Mailing address:
  • Phone: 952-993-8700
  • Fax: 952-993-8516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number62529
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: