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General NPI Number Information
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NPI Number | 1164928271
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Entity Type | Individual
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Provider Name | KELSI JEANETTE JORE SWANSON MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 2819 GREAT NORTHERN LOOP STE 200
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City | MISSOULA
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State | MT
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Zip | 59808-1750
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Country | US
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Telephone | 406-542-7525
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Fax | 406-829-0661
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Provider Business Mailing Address
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Address Line | PO BOX 7817
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City | MISSOULA
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State | MT
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Zip | 59807-7817
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Country | US
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Telephone | 406-542-7525
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Fax | 406-829-0661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD481377
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 73654
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License Number State | MT
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