Provider Demographics
NPI:1174158406
Name:SCHWARTZ, MARA L (RN, CDE)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:L
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 SPRING ST.
Mailing Address - Street 2:DIABTES EDUCATION DEPARTMENT
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646
Mailing Address - Country:US
Mailing Address - Phone:864-725-5007
Mailing Address - Fax:864-725-4125
Practice Address - Street 1:1226 SPRING ST.
Practice Address - Street 2:DIABTES EDUCATION DEPARTMENT
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:864-725-5007
Practice Address - Fax:864-725-4125
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC237627163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator