Provider Demographics
NPI:1841304243
Name:SWANSON, HEATHER KAY (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:KAY
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:138 MAIN ST S
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-4400
Practice Address - Country:US
Practice Address - Phone:320-468-2587
Practice Address - Fax:320-845-6138
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00086876OtherRAIL ROAD MC
MN01-14763OtherMEDICA
MN656S1SWOtherBLUE CROSS
MN781103900Medicaid
MNHP39979OtherHEALTH PARTNERS
MN135039OtherUCARE
MN1035400OtherPREFERRED ONE
MN80013003Medicare ID - Type Unspecified