Provider Demographics
NPI:1710170493
Name:SWIERCZEK, MISTY DAWN (PA)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:DAWN
Last Name:SWIERCZEK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:MISTY
Other - Middle Name:DAWN
Other - Last Name:ROEMELING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:625 S PINE ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:NE
Practice Address - Zip Code:68064-4400
Practice Address - Country:US
Practice Address - Phone:402-359-2277
Practice Address - Fax:402-359-5432
Is Sole Proprietor?:No
Enumeration Date:2007-08-25
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2466363AM0700X
NE1479363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1710170493Medicaid
NE47068731741Medicaid
NE47068731734Medicaid
NE10026480100Medicaid
NE47068731761Medicaid
NE47068731749Medicaid
NE47068731749Medicaid