Healthcare Provider Details

I. General information

NPI: 1053836239
Provider Name (Legal Business Name): MARIAH ANN FURY-SWISHER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAH A FURY

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 MAIN ST
LA PORTE CITY IA
50651-1235
US

IV. Provider business mailing address

213 MAIN ST
LA PORTE CITY IA
50651-1235
US

V. Phone/Fax

Practice location:
  • Phone: 319-505-5602
  • Fax: 319-575-6100
Mailing address:
  • Phone: 319-505-5602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG137147
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number137147
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: