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NPI Code Detail

MEDICARE: MS. THERESA J. SWENSON PA-C

MEDICARE: MS. THERESA J. SWENSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant001620IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P002085832OTHERIARAILROAD MEDICARE

General Provider Information

NPI Number : 1093713794
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. THERESA J. SWENSON PA-C
Provider Business Mailing Address
First Line : 2730 PIERCE ST STE 300
Second Line :
City : SIOUX CITY
State : IA
Zip : 51104-3765
Country : US
Telephone Number : 712-244-8677
Fax Number :
Provider Business Practice Location Address
First Line : 2730 PIERCE ST STE 300
Second Line :
City : SIOUX CITY
State : IA
Zip : 51104-3765
Country : US
Telephone Number : 712-224-8677
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 10/02/2019

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