Healthcare Provider Details

I. General information

NPI: 1467740183
Provider Name (Legal Business Name): MICHAEL SMITH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BARTON AVE
AUBURN ME
04210-6707
US

IV. Provider business mailing address

10 BARTON AVE
AUBURN ME
04210-6707
US

V. Phone/Fax

Practice location:
  • Phone: 207-784-4185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR030932
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: