Provider Demographics
NPI:1225231251
Name:SWIFT, MARY LUCILLE
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LUCILLE
Last Name:SWIFT
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 1:1305 KENNEDY CT
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-7007
Mailing Address - Country:US
Mailing Address - Phone:918-485-7461
Mailing Address - Fax:
Practice Address - Street 1:1305 KENNEDY CT
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-7007
Practice Address - Country:US
Practice Address - Phone:918-485-7461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK177F00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor