Provider Demographics
NPI:1710577259
Name:SWIERCZEK, MARK B (NP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:SWIERCZEK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 504938
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4938
Mailing Address - Country:US
Mailing Address - Phone:816-931-1883
Mailing Address - Fax:
Practice Address - Street 1:930 CARONDELET DR STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4698
Practice Address - Country:US
Practice Address - Phone:816-943-5690
Practice Address - Fax:816-943-2734
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014033861163W00000X
KS5380433363LF0000X
MO2021029688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse