MEDICARE: SHIRLEEN SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	49066	NE

General Provider Information

NPI Number	:	1043590490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEEN SMITH

Provider Business Mailing Address
First Line	:	320 WILLIAM AVE
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-6007
Country	:	US
Telephone Number	:	308-530-7194
Fax Number	:	308-532-0228

Provider Business Practice Location Address
First Line	:	320 WILLIAM AVE
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-6007
Country	:	US
Telephone Number	:	308-530-7194
Fax Number	:	308-532-0228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	08/17/2011

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Directions to “ SHIRLEEN SMITH ” Practice Location

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