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NPI Code Detail

MEDICARE: KRISTIN MICHELLE SMITH LPN

MEDICARE: KRISTIN MICHELLE SMITH LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramLP038658AZ

General Provider Information

NPI Number : 1164751137
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN MICHELLE SMITH LPN
Provider Business Mailing Address
First Line : 625 W CORNELL DR
Second Line :
City : TEMPE
State : AZ
Zip : 85283-1759
Country : US
Telephone Number : 480-897-6233
Fax Number : 480-838-0061
Provider Business Practice Location Address
First Line : 625 W CORNELL DR
Second Line :
City : TEMPE
State : AZ
Zip : 85283-1759
Country : US
Telephone Number : 480-897-6233
Fax Number : 480-838-0061
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2009
Last Update Date : 12/21/2009

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Directions to “ KRISTIN MICHELLE SMITH LPN” Practice Location

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