Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 3654 | SC |
NPI | 1851580864 |
---|---|
Provider Name | Dr. Mary Sweis |
First Address | Conway, SC 29528-2542 |
Second Address | Myrtle Beach, SC 29577-5664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2007 |
Last Update Date | 08/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
O05042012000157 | MEDICARE ENROLMENT ID (01) |