Healthcare Provider Details

I. General information

NPI: 1073427977
Provider Name (Legal Business Name): TIMOTHY SWANSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 LAKE RD
BOTTINEAU ND
58318-8217
US

IV. Provider business mailing address

PO BOX 29
BOTTINEAU ND
58318-0029
US

V. Phone/Fax

Practice location:
  • Phone: 701-648-9979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number127776
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: