Healthcare Provider Details

I. General information

NPI: 1679773147
Provider Name (Legal Business Name): PATRICIA SELZ SWANSON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 ARCADE ST
SAINT PAUL MN
55106-3852
US

IV. Provider business mailing address

860 ARCADE ST
SAINT PAUL MN
55106-3852
US

V. Phone/Fax

Practice location:
  • Phone: 651-793-2231
  • Fax: 651-312-1982
Mailing address:
  • Phone: 651-793-2231
  • Fax: 651-312-1982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1496
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: