Healthcare Provider Details

I. General information

NPI: 1841304243
Provider Name (Legal Business Name): HEATHER KAY SWANSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 MAIN ST S
PIERZ MN
56364-4400
US

IV. Provider business mailing address

1702 UNIVERSITY DR S
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 320-468-2587
  • Fax: 320-845-6138
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45626
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: