Provider Demographics
NPI:1679912133
Name:SWENSON, REBECCA HOLLY (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:HOLLY
Last Name:SWENSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:HOLLY
Other - Last Name:STRIKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:310 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4516
Mailing Address - Country:US
Mailing Address - Phone:701-877-2020
Mailing Address - Fax:701-639-2465
Practice Address - Street 1:310 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4516
Practice Address - Country:US
Practice Address - Phone:701-877-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020540208600000X
ND15099208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty