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General NPI Number Information
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NPI Number | 1578934527
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Entity Type | Individual
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Provider Name | CRAIG R SMITH RN, CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 945 N 12TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53233-1305
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Country | US
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Telephone | 414-219-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 800-326-2250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 7542-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209013492
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 041.401242
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License Number State | IL
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