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NPI Code Detail

MEDICARE: MRS. STEPHANIE RENEE SMITH RN

MEDICARE: MRS. STEPHANIE RENEE SMITH RN
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
1163W00000XRegistered Nurse4704319746MI
2163W00000XRegistered Nurse330593OH

General Provider Information

NPI Number : 1699282053
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHANIE RENEE SMITH RN
Provider Business Mailing Address
First Line : 4343 N TERRACE VIEW ST
Second Line :
City : TOLEDO
State : OH
Zip : 43607-1049
Country : US
Telephone Number : 419-346-0120
Fax Number : 844-489-1651
Provider Business Practice Location Address
First Line : 4343 N TERRACE VIEW ST
Second Line :
City : TOLEDO
State : OH
Zip : 43607-1049
Country : US
Telephone Number : 419-346-0120
Fax Number : 844-489-1651
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2018
Last Update Date : 01/08/2018

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