MEDICARE: TAMARA SUE 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
1	164W00000X	Licensed Practical Nurse	4703104604	MI

General Provider Information

NPI Number	:	1457166431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA SUE SMITH LPN

Provider Business Mailing Address
First Line	:	6230 S CURTIS RD
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-9524
Country	:	US
Telephone Number	:	989-584-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	4273 CORPORATE WAY
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-1082
Country	:	US
Telephone Number	:	989-953-4357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2025
Last Update Date	:	02/10/2025

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Directions to “ TAMARA SUE SMITH LPN” Practice Location

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