Provider Demographics
NPI:1700396280
Name:SWENSON, LISA MARIE (RDCS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SWENSON
Suffix:
Gender:F
Credentials:RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 FONDIE LN
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2069
Mailing Address - Country:US
Mailing Address - Phone:320-364-0758
Mailing Address - Fax:
Practice Address - Street 1:2653 FONDIE LN
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2069
Practice Address - Country:US
Practice Address - Phone:320-364-0758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152723246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography