Healthcare Provider Details

I. General information

NPI: 1609257419
Provider Name (Legal Business Name): KERRY SWIECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E BROAD ST
HAZLETON PA
18201-6835
US

IV. Provider business mailing address

6 CAMP DAVID RD
WAPWALLOPEN PA
18660-8814
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-4000
  • Fax:
Mailing address:
  • Phone: 570-582-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN587391
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: