Healthcare Provider Details

I. General information

NPI: 1861114613
Provider Name (Legal Business Name): MICHELLE M SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 VETERANS DR
FORT HARRISON MT
59636-9700
US

IV. Provider business mailing address

1952 UNIVERSITY ST
HELENA MT
59601-5920
US

V. Phone/Fax

Practice location:
  • Phone: 406-442-6410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number98697
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: