Healthcare Provider Details

I. General information

NPI: 1639972128
Provider Name (Legal Business Name): MEG ELAINE SWANSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W 66TH ST STE 150
EDINA MN
55435-2109
US

IV. Provider business mailing address

4225 GOLDEN VALLEY RD
MINNEAPOLIS MN
55422-4215
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-7200
  • Fax: 763-287-2303
Mailing address:
  • Phone: 651-387-6226
  • Fax: 952-674-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15505
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: