Provider Demographics
NPI:1609976083
Name:SWE, NI NI (MD)
Entity Type:Individual
Prefix:DR
First Name:NI NI
Middle Name:
Last Name:SWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CENTRAL DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5869
Mailing Address - Country:US
Mailing Address - Phone:817-571-9914
Mailing Address - Fax:817-571-0654
Practice Address - Street 1:1901 CENTRAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5869
Practice Address - Country:US
Practice Address - Phone:817-571-9915
Practice Address - Fax:817-571-0654
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH29702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC22429Medicare UPIN
TX00G21XMedicare ID - Type Unspecified