=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548317464
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SMITA NAGPAL PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 403 N BROAD ST
-----------------------------------------------------
City | ADRIAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49221-2127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-266-8500
-----------------------------------------------------
Fax | 866-223-1175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2376 WILDWOOD TRL
-----------------------------------------------------
City | SALINE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48176-1657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-266-8500
-----------------------------------------------------
Fax | 866-223-1175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TF0000X
-----------------------------------------------------
Taxonomy Name | Family Psychologist
-----------------------------------------------------
License Number | 6301011112
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------