Healthcare Provider Details

I. General information

NPI: 1730317827
Provider Name (Legal Business Name): SWAPNA DEVANNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SMITH AVE N STE 300
SAINT PAUL MN
55102-2383
US

IV. Provider business mailing address

PO BOX 43
MINNEAPOLIS MN
55440-0043
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-5111
  • Fax: 651-241-5512
Mailing address:
  • Phone: 612-262-1166
  • Fax: 612-262-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-128800
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number63636
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number63636
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: