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NPI Code Detail

MEDICARE: ELIZABETH ANNE SMITH N.P.

MEDICARE: ELIZABETH ANNE SMITH N.P.
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
1363LG0600XGerontology Nurse Practitioner4704228049MI

General Provider Information

NPI Number : 1770546632
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ANNE SMITH N.P.
Provider Business Mailing Address
First Line : 2249 WEALTHY ST SE
Second Line : STE 202
City : GRAND RAPIDS
State : MI
Zip : 49506-3052
Country : US
Telephone Number : 248-952-1601
Fax Number : 248-952-1614
Provider Business Practice Location Address
First Line : 2249 WEALTHY ST SE
Second Line : STE 202
City : GRAND RAPIDS
State : MI
Zip : 49506-3052
Country : US
Telephone Number : 248-952-1601
Fax Number : 248-952-1614
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2006
Last Update Date : 02/18/2016

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Directions to “ ELIZABETH ANNE SMITH N.P.” Practice Location

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