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General NPI Number Information
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NPI Number | 1174596951
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Entity Type | Individual
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Provider Name | ELIZABETH A SWANSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 1618 S MILLENIUM WAY STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-6457
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Country | US
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Telephone | 208-884-3376
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Fax | 208-884-0858
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Provider Business Mailing Address
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Address Line | 1618 S MILLENIUM WAY STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-6457
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Country | US
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Telephone | 208-884-3376
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Fax | 208-884-0858
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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 | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | M15214
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 49108
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License Number State | CO
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