Provider Demographics
NPI:1346357449
Name:SWAIN, HOLLY ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ANN
Last Name:SWAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:PEPOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:323 S. 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235
Mailing Address - Country:US
Mailing Address - Phone:920-743-5566
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:2345 CANTERBURY LN
Practice Address - Street 2:
Practice Address - City:SISTER BAY
Practice Address - State:WI
Practice Address - Zip Code:54234-5602
Practice Address - Country:US
Practice Address - Phone:920-868-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI467-023363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42934500Medicaid
17100-0022Medicare ID - Type UnspecifiedMEDICARE PROVIDER
WI42934500Medicaid