Healthcare Provider Details

I. General information

NPI: 1356331128
Provider Name (Legal Business Name): VIRGINIA FRANCES SMITH WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LAKESHORE DR
ISHPEMING MI
49849-1367
US

IV. Provider business mailing address

901 LAKESHORE DR
ISHPEMING MI
49849-1367
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-2613
  • Fax: 906-485-2731
Mailing address:
  • Phone: 906-485-2613
  • Fax: 906-485-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number107125030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209000519
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704269367
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: