Healthcare Provider Details

I. General information

NPI: 1174726392
Provider Name (Legal Business Name): KIRA L SMITH LNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 02/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 1019
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

85 SEYMOUR ST SUITE 1019
HARTFORD CT
06106-5501
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-4029
  • Fax: 860-240-7072
Mailing address:
  • Phone: 860-246-4029
  • Fax: 860-240-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000309
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: