Healthcare Provider Details

I. General information

NPI: 1609740463
Provider Name (Legal Business Name): CHLOEY ANN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 E FERNWOOD AVE
MILWAUKEE WI
53207-3177
US

IV. Provider business mailing address

1826 E FERNWOOD AVE
MILWAUKEE WI
53207-3177
US

V. Phone/Fax

Practice location:
  • Phone: 414-758-8818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number266409-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: