Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | R37237 | ND |
NPI | 1063822062 |
---|---|
Provider Name | Amanda Swanson |
First Address | Fargo, ND 58108-6001 |
Second Address | Fargo, ND 58103-6132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 04/12/2018 |