Healthcare Provider Details

I. General information

NPI: 1700601101
Provider Name (Legal Business Name): MARGARET LYNN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 CACTUS FLOWER
CIBOLO TX
78108-3491
US

IV. Provider business mailing address

428 CACTUS FLOWER
CIBOLO TX
78108-3491
US

V. Phone/Fax

Practice location:
  • Phone: 540-207-3865
  • Fax:
Mailing address:
  • Phone: 540-207-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number1011947
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: