MEDICARE: BRIELLE JOY SWANSTROM MD

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
1	208000000X	Pediatrics Physician	62529	MN

General Provider Information

NPI Number	:	1225492739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIELLE JOY SWANSTROM MD

Provider Business Mailing Address
First Line	:	14000 FAIRVIEW DR
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4571
Country	:	US
Telephone Number	:	952-993-8700
Fax Number	:	952-993-8516

Provider Business Practice Location Address
First Line	:	610 30TH AVE W
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-3426
Country	:	US
Telephone Number	:	320-763-2540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	05/12/2026

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