Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 3121400 | TX |
Y | 213ES0000X | Sports Medicine | 3121400 | TX |
NPI | 1093231797 |
---|---|
Provider Name | Ms. Melissa Rene Swenson |
First Address | San Antonio, TX 78240-1679 |
Second Address | San Antonio, TX 78240-1679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2017 |
Last Update Date | 10/03/2021 |