Healthcare Provider Details

I. General information

NPI: 1427232388
Provider Name (Legal Business Name): JESSICA J SWANSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. JESSICA J EVANS

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 09/20/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BORTHWICK AVE SUITE 308
PORTSMOUTH NH
03801
US

IV. Provider business mailing address

401 KENDALL DRIVE
LAMAR CO
81052-3943
US

V. Phone/Fax

Practice location:
  • Phone: 603-334-6260
  • Fax: 603-334-6253
Mailing address:
  • Phone: 719-336-7005
  • Fax: 719-336-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number235512
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number47781
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: