Provider Demographics
NPI:1114641933
Name:MCSWAIN, GENA M
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:M
Last Name:MCSWAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 N OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-2724
Mailing Address - Country:US
Mailing Address - Phone:405-528-8686
Mailing Address - Fax:405-528-8692
Practice Address - Street 1:2701 N OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-2724
Practice Address - Country:US
Practice Address - Phone:405-528-8686
Practice Address - Fax:405-528-8692
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator