Provider Demographics
NPI:1750948535
Name:SWANSON, KRISTINA (RDN, LDN)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8647
Mailing Address - Country:US
Mailing Address - Phone:612-499-6015
Mailing Address - Fax:
Practice Address - Street 1:1733 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8647
Practice Address - Country:US
Practice Address - Phone:612-499-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4110133V00000X
IL164.008826133V00000X
MO2022013309133V00000X
NE1632133V00000X
WI3861133V00000X
IA112011133V00000X
SD0836133V00000X
KS2718133V00000X
MN133V00000X
TXDT88512133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered