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General NPI Number Information
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NPI Number | 1760115448
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Entity Type | Individual
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Provider Name | JENNIFER LYNN SMITH AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 43475 DALCOMA DR STE 150
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-3594
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Country | US
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Telephone | 248-784-3667
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Fax | 248-869-3982
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Provider Business Mailing Address
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Address Line | 25500 MEADOWBROOK RD STE 150
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City | NOVI
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State | MI
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Zip | 48375-1880
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Country | US
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Telephone | 248-784-3667
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Fax | 248-869-3982
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704295607
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License Number State | MI
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