Healthcare Provider Details

I. General information

NPI: 1316886203
Provider Name (Legal Business Name): LISA ESTEY-SWICK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30346 W SHORE DR
PENGILLY MN
55775-2246
US

IV. Provider business mailing address

30346 W SHORE DR
PENGILLY MN
55775-2246
US

V. Phone/Fax

Practice location:
  • Phone: 218-969-1626
  • Fax:
Mailing address:
  • Phone: 218-969-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR181310-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: