Healthcare Provider Details

I. General information

NPI: 1255679890
Provider Name (Legal Business Name): DAWN M SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 BELLE CHASE WAY
LANSING MI
48911-4252
US

IV. Provider business mailing address

3475 BELLE CHASE WAY
LANSING MI
48911-4252
US

V. Phone/Fax

Practice location:
  • Phone: 517-303-8044
  • Fax:
Mailing address:
  • Phone: 517-331-0989
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704279886
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704279886
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: