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NPI Code Detail

MEDICARE: THERESA SMITH

MEDICARE:   THERESA  SMITH
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
1163WP0808XPsychiatric/Mental Health Registered Nurse4704313668MI

General Provider Information

NPI Number : 1528915139
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA SMITH
Provider Business Mailing Address
First Line : 4646 JOHN R ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-1916
Country : US
Telephone Number : 313-576-1000
Fax Number :
Provider Business Practice Location Address
First Line : 4646 JOHN R ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-1916
Country : US
Telephone Number : 313-576-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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Directions to “ THERESA SMITH ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.