Provider Demographics
NPI:1346443801
Name:SWICK, MARY DEE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DEE
Last Name:SWICK
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 1:568 ROXANNE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4111
Mailing Address - Country:US
Mailing Address - Phone:615-833-2967
Mailing Address - Fax:615-880-2194
Practice Address - Street 1:224 ORIEL AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4910
Practice Address - Country:US
Practice Address - Phone:615-862-7940
Practice Address - Fax:615-880-2194
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000035769164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse