Provider Demographics
NPI:1891942405
Name:SWENSON, LEAH KATHRYN (FNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:KATHRYN
Last Name:SWENSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:KATHRYN
Other - Last Name:MYOGETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-845-8060
Mailing Address - Fax:701-845-8067
Practice Address - Street 1:132 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3056
Practice Address - Country:US
Practice Address - Phone:701-845-8060
Practice Address - Fax:701-845-8067
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR23542363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1458623Medicaid
NDN714142Medicare PIN