Provider Demographics
NPI:1215010160
Name:SWANER, MARY JO (RN,BSN)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:SWANER
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69005 QUAIL TREE DR
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-9772
Mailing Address - Country:US
Mailing Address - Phone:541-923-6290
Mailing Address - Fax:541-923-8272
Practice Address - Street 1:69005 QUAIL TREE DR
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-9772
Practice Address - Country:US
Practice Address - Phone:541-923-6290
Practice Address - Fax:541-923-8272
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health