Healthcare Provider Details

I. General information

NPI: 1033590088
Provider Name (Legal Business Name): NATHAN DEAN SWENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BEAM AVE
MAPLEWOOD MN
55109-1126
US

IV. Provider business mailing address

2829 UNIVERSITY AVE SE SUITE 730
MINNEAPOLIS MN
55414
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-7348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number87244-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number63575
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: