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General NPI Number Information
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NPI Number | 1689159162
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Entity Type | Individual
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Provider Name | MARIYA A SMIRNOVA NP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 601 JOHN ST STE N1200
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City | KALAMAZOO
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State | MI
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Zip | 49007-5318
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Country | US
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Telephone | 269-349-9745
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Fax |
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Provider Business Mailing Address
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Address Line | 601 ELMWOOD AVENUE BOX 656
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City | ROCHESTER
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State | NY
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Zip | 14642-0001
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Country | US
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Telephone | 585-756-4011
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 308732-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704412688
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License Number State | MI
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