Healthcare Provider Details

I. General information

NPI: 1649949744
Provider Name (Legal Business Name): MARIA SOLEDADE SANTOS SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WASON AVE
SPRINGFIELD MA
01107-1140
US

IV. Provider business mailing address

101 WASON AVE
SPRINGFIELD MA
01107-1140
US

V. Phone/Fax

Practice location:
  • Phone: 413-306-3599
  • Fax:
Mailing address:
  • Phone: 413-306-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN277349
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: