Healthcare Provider Details

I. General information

NPI: 1760314744
Provider Name (Legal Business Name): RENITA RAE MAYO-SWANIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LAKEVIEW AVE
SAINT JOSEPH MI
49085-2379
US

IV. Provider business mailing address

715 W ROE ST
BUCHANAN MI
49107-1027
US

V. Phone/Fax

Practice location:
  • Phone: 269-983-0177
  • Fax:
Mailing address:
  • Phone: 269-635-0978
  • Fax: 269-635-0978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: