Provider Demographics
NPI:1265404784
Name:SWIETNICKI, SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:SWIETNICKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1231
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-1231
Mailing Address - Country:US
Mailing Address - Phone:406-262-1302
Mailing Address - Fax:406-265-1651
Practice Address - Street 1:505 NE 87TH AVE STE 160
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1965
Practice Address - Country:US
Practice Address - Phone:360-514-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10554207V00000X
WAMD60244750207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000096995OtherBLUE CROSS BLUE SHIELD
MT1265404784Medicaid
P00324537OtherMEDICARE RAILROAD
MT1265404784Medicaid
MT000083973Medicare ID - Type Unspecified
000083973Medicare PIN