Healthcare Provider Details

I. General information

NPI: 1639527419
Provider Name (Legal Business Name): MEGHAN SMITH RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 W. GARDEN OF THE GODS ROAD
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

1675 W. GARDEN OF THE GODS ROAD
COLORADO SPRINGS CO
80907
US

V. Phone/Fax

Practice location:
  • Phone: 719-339-4129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN.1628571
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: