Healthcare Provider Details

I. General information

NPI: 1144919747
Provider Name (Legal Business Name): MICHELLE LYNN SMITH APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 SECOR RD
TOLEDO OH
43623-4299
US

IV. Provider business mailing address

128 BIRCHCREST DR
PERRYSBURG OH
43551-1801
US

V. Phone/Fax

Practice location:
  • Phone: 419-479-5728
  • Fax:
Mailing address:
  • Phone: 419-508-6707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0033738
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0033738
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: