Provider Demographics
NPI:1487014627
Name:SWAYZE, ROBERT M (MSN, APN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:SWAYZE
Suffix:
Gender:M
Credentials:MSN, APN, FNP-BC
Other - Prefix:
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Mailing Address - Street 1:1009 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1841
Mailing Address - Country:US
Mailing Address - Phone:618-985-4344
Mailing Address - Fax:618-985-6469
Practice Address - Street 1:310 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-1980
Practice Address - Country:US
Practice Address - Phone:618-985-4344
Practice Address - Fax:618-985-6469
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL364132769207Q00000X
IL209013916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine