Provider Demographics
NPI:1790140465
Name:SWAFFORD, MARSHA MARIE
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:MARIE
Last Name:SWAFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 E MOSES
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023
Mailing Address - Country:US
Mailing Address - Phone:918-225-5600
Mailing Address - Fax:918-225-3026
Practice Address - Street 1:1405 E MOSES
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023
Practice Address - Country:US
Practice Address - Phone:918-225-5600
Practice Address - Fax:918-225-3026
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100686560AMedicaid