Healthcare Provider Details

I. General information

NPI: 1831247980
Provider Name (Legal Business Name): HELEN C. SMITH CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 SE MAIN ST SUITE 220
SIMPSONVILLE SC
29681-3247
US

IV. Provider business mailing address

104 BURDOCK WAY
SIMPSONVILLE SC
29681-5514
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-6613
  • Fax:
Mailing address:
  • Phone: 864-458-8206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number24415
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: