Healthcare Provider Details

I. General information

NPI: 1659074011
Provider Name (Legal Business Name): COLBY SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3791 10TH STREET
EDINBURGH IN
46124
US

IV. Provider business mailing address

836 E DRYBREAD LN
NINEVEH IN
46164-8603
US

V. Phone/Fax

Practice location:
  • Phone: 812-348-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number28188221A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: