Healthcare Provider Details

I. General information

NPI: 1700013661
Provider Name (Legal Business Name): ERIC N. SWENSEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ONYX ST
KEMMERER WY
83101-3214
US

IV. Provider business mailing address

711 ONYX ST
KEMMERER WY
83101-3214
US

V. Phone/Fax

Practice location:
  • Phone: 307-877-4496
  • Fax: 307-877-9769
Mailing address:
  • Phone: 307-877-4496
  • Fax: 307-877-9769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02003719A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8939A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: