Provider Demographics
NPI:1033287990
Name:SWIRCENSKI, MARK STEPHEN (PAC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEPHEN
Last Name:SWIRCENSKI
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20440 RAVEN DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577
Mailing Address - Country:US
Mailing Address - Phone:907-229-2473
Mailing Address - Fax:
Practice Address - Street 1:4200 LAKE OTIS PKWY
Practice Address - Street 2:ALASKA FAMILY WELLNESS CENTER INC., SUITE 304
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5215
Practice Address - Country:US
Practice Address - Phone:907-561-9444
Practice Address - Fax:907-561-9446
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPA235363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S54283Medicare UPIN
50879Medicare PIN