Healthcare Provider Details

I. General information

NPI: 1902845795
Provider Name (Legal Business Name): STEPHANIE ANN SMART NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2198 US 31 S
MANISTEE MI
49660-9618
US

IV. Provider business mailing address

6227 FRANKFORT HWY
BENZONIA MI
49616-8632
US

V. Phone/Fax

Practice location:
  • Phone: 231-723-3567
  • Fax:
Mailing address:
  • Phone: 231-723-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704150277
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: