Basic Information
| Provider Information | |||||||||
| NPI: | 1255337176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWANSON | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 WEST KIMBERLY ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633559191 | ||||||||
| FaxNumber: | 5633553419 | ||||||||
| Practice Location | |||||||||
| Address1: | 1351 W CENTRAL PARK AVE | ||||||||
| Address2: | STE 4100 | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528041847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633832581 | ||||||||
| FaxNumber: | 5633285770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 01/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | C065518 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 19775 | 01 | IOWA HEALTH SOLUTIONS | OTHER | 0424903 | 05 | IA | MEDICAID | 29743 | 01 | WELLMARK HEALTH PLANS | OTHER | 063069 | 01 | HEALTH ALLIANCE | OTHER | IA0157 | 01 | JOHN DEERE HEALTH PLANS | OTHER |