Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 53839 | MN |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 53839 | MN |
NPI | 1093932709 |
---|---|
Provider Name | Aaron Wendell Swenson |
First Address | Maple Grove, MN 55369 |
Second Address | Maple Grove, MN 55369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 17/01/2019 |