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General NPI Number Information
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NPI Number | 1609173285
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Entity Type | Individual
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Provider Name | GAIL SMITH
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Gender | Female
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 5242 LAPEER RD SUITE D
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City | BURTON
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State | MI
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Zip | 48509-2224
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Country | US
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Telephone | 810-742-3925
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Fax | 810-742-3926
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Provider Business Mailing Address
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Address Line | 5242 LAPEER RD SUITE D
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City | BURTON
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State | MI
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Zip | 48509-2224
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Country | US
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Telephone | 810-577-5245
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703024043
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License Number State | MI
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