Provider Demographics
NPI:1174313985
Name:SWICK, MARY MAE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MAE
Last Name:SWICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MAE
Other - Last Name:BRINDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 N UNION ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PONCA
Mailing Address - State:NE
Mailing Address - Zip Code:68770-7297
Mailing Address - Country:US
Mailing Address - Phone:660-654-0118
Mailing Address - Fax:
Practice Address - Street 1:117 N UNION ST STE 1
Practice Address - Street 2:
Practice Address - City:PONCA
Practice Address - State:NE
Practice Address - Zip Code:68770-7297
Practice Address - Country:US
Practice Address - Phone:712-251-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty