Provider Demographics
NPI:1619454105
Name:SWAIN, MEGAN MARY (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARY
Last Name:SWAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 N MACKINAC TRL
Mailing Address - Street 2:
Mailing Address - City:RUDYARD
Mailing Address - State:MI
Mailing Address - Zip Code:49780-9534
Mailing Address - Country:US
Mailing Address - Phone:920-559-6000
Mailing Address - Fax:
Practice Address - Street 1:1140 N STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1048
Practice Address - Country:US
Practice Address - Phone:906-643-1188
Practice Address - Fax:906-643-0461
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4879363A00000X
MI5601010797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant