Provider Demographics
NPI:1609257419
Name:SWIECH, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:SWIECH
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 1:6 CAMP DAVID RD
Mailing Address - Street 2:
Mailing Address - City:WAPWALLOPEN
Mailing Address - State:PA
Mailing Address - Zip Code:18660-8814
Mailing Address - Country:US
Mailing Address - Phone:570-582-6624
Mailing Address - Fax:
Practice Address - Street 1:700 E BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6835
Practice Address - Country:US
Practice Address - Phone:570-501-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN587391367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered