Healthcare Provider Details

I. General information

NPI: 1659181105
Provider Name (Legal Business Name): ELIZABETH SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH STACHNIK

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 SIXTH ST STE 300
TRAVERSE CITY MI
49684-2360
US

IV. Provider business mailing address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2345
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-2400
  • Fax: 231-392-2424
Mailing address:
  • Phone: 231-935-7549
  • Fax: 231-392-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4704363158
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704363158
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: