Healthcare Provider Details

I. General information

NPI: 1821502725
Provider Name (Legal Business Name): JULIANN M. SMITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIANN M. WEISS CRNA

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

PO BOX 670884
DETROIT MI
48267-0884
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-7836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704429508
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN568606
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD184981
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1132862
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: