Provider Demographics
NPI:1093713794
Name:SWENSON, THERESA J (PA-C)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:J
Last Name:SWENSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:J
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2730 PIERCE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3765
Mailing Address - Country:US
Mailing Address - Phone:712-244-8677
Mailing Address - Fax:
Practice Address - Street 1:2730 PIERCE ST STE 300
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3765
Practice Address - Country:US
Practice Address - Phone:712-224-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP002085832OtherRAILROAD MEDICARE
IAP002085832OtherRAILROAD MEDICARE
IA001620Medicare PIN