Provider Demographics
NPI:1467885913
Name:SCHWIEN, STACEY L (PA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:SCHWIEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23450 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-8702
Mailing Address - Country:US
Mailing Address - Phone:913-764-7788
Mailing Address - Fax:913-764-6088
Practice Address - Street 1:23450 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-8702
Practice Address - Country:US
Practice Address - Phone:913-764-7788
Practice Address - Fax:913-764-6088
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01632363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201091620AMedicaid
KS033D00102Medicare PIN