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General NPI Number Information
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NPI Number | 1639920788
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Entity Type | Individual
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Provider Name | HOLLY SMITH LPN
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Gender | Female
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 1109 COBB AVE
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City | KALAMAZOO
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State | MI
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Zip | 49007-2449
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Country | US
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Telephone | 910-650-8828
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Fax |
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Provider Business Mailing Address
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Address Line | 167 N DRAKE RD P.O BOX 20421
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City | KALAMAZOO
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State | MI
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Zip | 49009
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Country | US
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Telephone |
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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 | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703120614
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License Number State | MI
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