Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | H3639 | MN |
NPI | 1568076073 |
---|---|
Provider Name | Rae Ann Ann Swanson |
First Address | Minneapolis, MN 55426-1784 |
Second Address | Minneapolis, MN 55426-1784 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2020 |
Last Update Date | 02/09/2020 |