Healthcare Provider Details

I. General information

NPI: 1265404784
Provider Name (Legal Business Name): SUZANNE SWIETNICKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 160
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

PO BOX 1231
HAVRE MT
59501-1231
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-1060
  • Fax:
Mailing address:
  • Phone: 406-262-1302
  • Fax: 406-265-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10554
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60244750
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: