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General NPI Number Information
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NPI Number | 1831784370
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Entity Type | Individual
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Provider Name | MACKENZIE LYNN SMITH RRT
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Gender | Female
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Dates
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Enumeration Date | 03/06/2021
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 29 LOWELL ST
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City | LEWISTON
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State | ME
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Zip | 04240-7639
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Country | US
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Telephone | 207-649-8795
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Fax |
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Provider Business Mailing Address
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Address Line | 12 GREENWOOD ST
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City | WATERVILLE
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State | ME
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Zip | 04901
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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 | 2279C0205X
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Taxonomy Name | Critical Care Registered Respiratory Therapist
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License Number | TH2557
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License Number State | ME
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