Healthcare Provider Details

I. General information

NPI: 1477614675
Provider Name (Legal Business Name): JOAN KATHLEEN SMYTH MSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 CHELSEA ST LOWER LEVEL
EVERETT MA
02149
US

IV. Provider business mailing address

173 CHELSEA ST LOWER LEVEL
EVERETT MA
02149
US

V. Phone/Fax

Practice location:
  • Phone: 781-388-6244
  • Fax: 781-388-6240
Mailing address:
  • Phone: 781-388-6244
  • Fax: 781-388-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number105254
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: