Healthcare Provider Details

I. General information

NPI: 1831784370
Provider Name (Legal Business Name): MACKENZIE LYNN SMITH RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 10/28/2022
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 LOWELL ST
LEWISTON ME
04240-7639
US

IV. Provider business mailing address

12 GREENWOOD ST
WATERVILLE ME
04901
US

V. Phone/Fax

Practice location:
  • Phone: 207-649-8795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberTH2557
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: