Provider Demographics
NPI:1508170093
Name:SWARTZ-ROGACKI, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SWARTZ-ROGACKI
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 1:12342 BIG TREE ROAD
Mailing Address - Street 2:
Mailing Address - City:WALES CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14169-0000
Mailing Address - Country:US
Mailing Address - Phone:716-652-8565
Mailing Address - Fax:
Practice Address - Street 1:12342 BIG TREE ROAD
Practice Address - Street 2:
Practice Address - City:WALES CENTER
Practice Address - State:NY
Practice Address - Zip Code:14169-0000
Practice Address - Country:US
Practice Address - Phone:716-652-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265766-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse