MEDICARE: KENDRA CHARANNE SMOLEN

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1578692711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA CHARANNE SMOLEN

Provider Business Mailing Address
First Line	:	3099 NW 91ST AVE
Second Line	:	#202
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5077
Country	:	US
Telephone Number	:	954-340-3056
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 SW 27TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-2051
Country	:	US
Telephone Number	:	954-791-4300
Fax Number	:	954-497-3857

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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Directions to “ KENDRA CHARANNE SMOLEN ” Practice Location

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