Provider Demographics
NPI:1255337176
Name:SWANSON, BRENDA L (ARNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:SWANSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 WEST KIMBERLY ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:1351 W CENTRAL PARK AVE
Practice Address - Street 2:STE 4100
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1847
Practice Address - Country:US
Practice Address - Phone:563-383-2581
Practice Address - Fax:563-328-5770
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC065518363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
19775OtherIOWA HEALTH SOLUTIONS
IA0424903Medicaid
29743OtherWELLMARK HEALTH PLANS
063069OtherHEALTH ALLIANCE
IA0157OtherJOHN DEERE HEALTH PLANS
19775OtherIOWA HEALTH SOLUTIONS
IA0424903Medicaid