Healthcare Provider Details

I. General information

NPI: 1669944088
Provider Name (Legal Business Name): ANDREW BRYAN SMITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2018
Last Update Date: 12/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 GRAND RIVER RD
BRIGHTON MI
48114-9309
US

IV. Provider business mailing address

1668 SAVANNAH CT
YPSILANTI MI
48198-3682
US

V. Phone/Fax

Practice location:
  • Phone: 810-844-7575
  • Fax:
Mailing address:
  • Phone: 517-281-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number124782
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: