Provider Demographics
NPI:1730382094
Name:SWANSON, KRISTIN ELNA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ELNA
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 1:1300 BADGER ST
Mailing Address - Street 2:UW-LA CROSSE STUDENT HEALTH CENTER
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-1502
Mailing Address - Country:US
Mailing Address - Phone:608-785-8558
Mailing Address - Fax:
Practice Address - Street 1:1300 BADGER ST
Practice Address - Street 2:UW-LA CROSSE STUDENT HEALTH CENTER
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-1502
Practice Address - Country:US
Practice Address - Phone:608-785-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB56999Medicare UPIN