Healthcare Provider Details

I. General information

NPI: 1861243255
Provider Name (Legal Business Name): DR. ELINA SMILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 BLUE LAKE BLVD
ARLINGTON TX
76005-4527
US

IV. Provider business mailing address

1217 BLUE LAKE BLVD
ARLINGTON TX
76005-4527
US

V. Phone/Fax

Practice location:
  • Phone: 217-751-2625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: