Healthcare Provider Details

I. General information

NPI: 1649598764
Provider Name (Legal Business Name): LORI MICHELLE SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 HIGHLAND DR
SLC UT
84124-3543
US

IV. Provider business mailing address

4460 HIGHLAND DR
SLC UT
84124-3543
US

V. Phone/Fax

Practice location:
  • Phone: 801-273-1085
  • Fax:
Mailing address:
  • Phone: 801-273-1085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number286248-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: