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General NPI Number Information
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NPI Number | 1720801038
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Entity Type | Organization
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Legal Business Name | BLUESTEM OSTEOPATHY LLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 17660 SAINT CROIX TRL N
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City | MARINE ON SAINT CROIX
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State | MN
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Zip | 55047-9763
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Country | US
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Telephone | 920-428-0133
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Fax |
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Provider Business Mailing Address
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Address Line | 17660 SAINT CROIX TRL N
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City | MARINE ON SAINT CROIX
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State | MN
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Zip | 55047-9763
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Country | US
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Telephone | 920-428-0133
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Fax |
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Authorized Official
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Title or Position | OWNER / CEO
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Name | DR. KATHERINE SWANSON
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Credential | DO
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Telephone | 920-428-0133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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