Healthcare Provider Details

I. General information

NPI: 1003293689
Provider Name (Legal Business Name): MARY SWINGLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2015
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
MERRIAM KS
66204-4004
US

IV. Provider business mailing address

9100 W 74TH ST
OVERLAND PARK KS
66204-4004
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-2230
  • Fax:
Mailing address:
  • Phone: 913-428-2900
  • Fax: 913-428-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2015016928
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-99853-031
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2006030230
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43-557346-031
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: