Healthcare Provider Details

I. General information

NPI: 1265351043
Provider Name (Legal Business Name): NATALIE SMITH CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 NORTHLAND DR NE
ROCKFORD MI
49341-9852
US

IV. Provider business mailing address

726 OLD GATE RD NW
GRAND RAPIDS MI
49504-4736
US

V. Phone/Fax

Practice location:
  • Phone: 616-514-7569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704348680
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: