Healthcare Provider Details

I. General information

NPI: 1487050407
Provider Name (Legal Business Name): JULIA LAVETTE SMITH RN BS BSN CHPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 ATKINSON ST
DETROIT MI
48202-1521
US

IV. Provider business mailing address

4406 3RD ST
DETROIT MI
48201-1134
US

V. Phone/Fax

Practice location:
  • Phone: 248-804-2457
  • Fax:
Mailing address:
  • Phone: 248-804-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704249595
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number4704249595
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: