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General NPI Number Information
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NPI Number | 1902845795
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Entity Type | Individual
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Provider Name | STEPHANIE ANN SMART NP
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 2198 US 31 S
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City | MANISTEE
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State | MI
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Zip | 49660-9618
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Country | US
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Telephone | 231-723-3567
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Fax |
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Provider Business Mailing Address
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Address Line | 6227 FRANKFORT HWY
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City | BENZONIA
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State | MI
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Zip | 49616-8632
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Country | US
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Telephone | 231-723-3567
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704150277
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License Number State | MI
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