Healthcare Provider Details

I. General information

NPI: 1508557711
Provider Name (Legal Business Name): HEATHER RENEE SMITH CPM LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ELECTRIC RD
ROANOKE VA
24018-1621
US

IV. Provider business mailing address

1950 ELECTRIC RD
ROANOKE VA
24018-1621
US

V. Phone/Fax

Practice location:
  • Phone: 312-533-6823
  • Fax: 540-301-1768
Mailing address:
  • Phone: 312-533-6823
  • Fax: 540-301-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129000185
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: