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NPI Code Detail

MEDICARE: MARK DAVID SWENSON CRNA

MEDICARE: MARK DAVID SWENSON CRNA
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
1367500000XCertified Registered Nurse Anesthetist1344626MN
2367500000XCertified Registered Nurse Anesthetist54863MN
3367500000XCertified Registered Nurse Anesthetist337MN

General Provider Information

NPI Number : 1275508111
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK DAVID SWENSON CRNA
Provider Business Mailing Address
First Line : 500 W GRANT ST
Second Line :
City : LAKE CITY
State : MN
Zip : 55041-1143
Country : US
Telephone Number : 651-345-3321
Fax Number :
Provider Business Practice Location Address
First Line : 500 W GRANT ST
Second Line :
City : LAKE CITY
State : MN
Zip : 55041-1143
Country : US
Telephone Number : 651-345-3321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 06/10/2019

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