Healthcare Provider Details

I. General information

NPI: 1275451809
Provider Name (Legal Business Name): JERI SMITH ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 MCHENRY ST
BURLINGTON WI
53105-1828
US

IV. Provider business mailing address

252 MCHENRY ST
BURLINGTON WI
53105-1828
US

V. Phone/Fax

Practice location:
  • Phone: 262-767-6302
  • Fax:
Mailing address:
  • Phone: 262-767-6302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number102713-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: