Healthcare Provider Details

I. General information

NPI: 1184540478
Provider Name (Legal Business Name): JULIE ANNE SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 MICHIGAN AVE
HOLLAND MI
49423-4918
US

IV. Provider business mailing address

602 MICHIGAN AVE
HOLLAND MI
49423-4918
US

V. Phone/Fax

Practice location:
  • Phone: 616-394-3653
  • Fax:
Mailing address:
  • Phone: 616-394-3653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4704217368
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: