Healthcare Provider Details

I. General information

NPI: 1548506405
Provider Name (Legal Business Name): MANDI SUE SWANSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDI SUE DICKEY FNP

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 COON RAPIDS BLVD NW STE 100
COON RAPIDS MN
55433-2697
US

IV. Provider business mailing address

4225 GOLDEN VALLEY RD
GOLDEN VALLEY MN
55422-4215
US

V. Phone/Fax

Practice location:
  • Phone: 763-427-8320
  • Fax: 763-287-2303
Mailing address:
  • Phone: 763-302-4100
  • Fax: 952-345-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3236
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1568017
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: