Provider Demographics
NPI:1437697356
Name:SWANSON, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2126
Mailing Address - Country:US
Mailing Address - Phone:816-983-5959
Mailing Address - Fax:816-889-4699
Practice Address - Street 1:2121 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2126
Practice Address - Country:US
Practice Address - Phone:816-983-5959
Practice Address - Fax:816-889-4699
Is Sole Proprietor?:No
Enumeration Date:2017-02-11
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101023508207V00000X
MI5151013078207V00000X
MO2021031577207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology