Healthcare Provider Details

I. General information

NPI: 1154626257
Provider Name (Legal Business Name): JEANNA SWANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLEVELAND AVE N
ROSEVILLE MN
55113-1126
US

IV. Provider business mailing address

2800 CLEVELAND AVE N
ROSEVILLE MN
55113-1126
US

V. Phone/Fax

Practice location:
  • Phone: 651-642-1825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR 190838-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: