Provider Demographics
NPI:1427232388
Name:SWANSON, JESSICA J (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:J
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:J
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 KENDALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3943
Mailing Address - Country:US
Mailing Address - Phone:719-336-7005
Mailing Address - Fax:719-336-7026
Practice Address - Street 1:330 BORTHWICK AVE SUITE 308
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-334-6260
Practice Address - Fax:603-334-6253
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235512208600000X
CO47781208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery