Provider Demographics
NPI:1992129985
Name:SWANSON-HILL, HEATHER ANN (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:SWANSON-HILL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 GOLF COURSE ROAD
Mailing Address - Street 2:GRAND ITASCA CLINIC & HOSPITAL
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744
Mailing Address - Country:US
Mailing Address - Phone:218-326-5000
Mailing Address - Fax:
Practice Address - Street 1:1601 GOLF COURSE ROAD
Practice Address - Street 2:GRAND ITASCA CLINIC & HOSPITAL
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744
Practice Address - Country:US
Practice Address - Phone:218-326-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76268363L00000X
MNCNP4236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1992129985Medicaid
KS201093820AMedicaid
KS068002253OtherMEDICARE PTAN