Provider Demographics
NPI:1891978433
Name:SWINTZ, MYRA LEANN (RN, NCTMB)
Entity Type:Individual
Prefix:MS
First Name:MYRA
Middle Name:LEANN
Last Name:SWINTZ
Suffix:
Gender:F
Credentials:RN, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:520 N MADISON AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-4083
Mailing Address - Country:US
Mailing Address - Phone:317-319-0865
Mailing Address - Fax:317-859-0866
Practice Address - Street 1:904 RAMBLIN RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-8356
Practice Address - Country:US
Practice Address - Phone:317-319-0865
Practice Address - Fax:317-859-0866
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28092030A163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)