Provider Demographics
NPI:1740023589
Name:SWAYNE, MIA NICCOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:NICCOLE
Last Name:SWAYNE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:NICCOLE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:210 STERLING RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-8395
Mailing Address - Country:US
Mailing Address - Phone:937-217-4585
Mailing Address - Fax:
Practice Address - Street 1:210 STERLING RUN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-8395
Practice Address - Country:US
Practice Address - Phone:937-444-6995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily