Provider Demographics
NPI:1790111292
Name:SWENSON, MARIE GRACE (NP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:GRACE
Last Name:SWENSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2101
Mailing Address - Country:US
Mailing Address - Phone:314-691-7902
Mailing Address - Fax:
Practice Address - Street 1:835 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-1815
Practice Address - Country:US
Practice Address - Phone:732-969-2240
Practice Address - Fax:732-969-2152
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004635A363LF0000X
NJ26NJ00523300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily