Healthcare Provider Details

I. General information

NPI: 1134639941
Provider Name (Legal Business Name): QUINETTE SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6580 S 46TH ST
FRANKLIN WI
53132-8153
US

IV. Provider business mailing address

6033 N 112TH ST
MILWAUKEE WI
53225-1201
US

V. Phone/Fax

Practice location:
  • Phone: 414-758-0019
  • Fax:
Mailing address:
  • Phone: 414-202-4424
  • Fax: 414-368-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number220178
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: