Healthcare Provider Details

I. General information

NPI: 1861290876
Provider Name (Legal Business Name): KIANNA SWANSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 06/19/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CURVE CREST BLVD W
STILLWATER MN
55082-5085
US

IV. Provider business mailing address

4532 MAJESTIC OAKS PL
EAGAN MN
55123-3076
US

V. Phone/Fax

Practice location:
  • Phone: 651-275-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4013
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: