Provider Demographics
NPI:1245314772
Name:SWICK, LYNN MARIE (NP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:SWICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-728-4789
Practice Address - Street 1:1150 E SHERMAN BLVD
Practice Address - Street 2:SUITE 1175
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1871
Practice Address - Country:US
Practice Address - Phone:231-672-6740
Practice Address - Fax:231-672-6787
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704120638363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008761900OtherBCBS
MI4363462Medicaid
MI0N55170002OtherMEDICARE ADVANTAGE
MI1057816OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI500018021OtherRAILROAD MEDICARE
MI9133215OtherAETNA
MI4363462Medicaid
MIS58213Medicare UPIN