MEDICARE: BRITNEY LEE SMITH CRNA

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	4704317143	MI
2	367500000X	Certified Registered Nurse Anesthetist	4704317143	MI

General Provider Information

NPI Number	:	1134791189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITNEY LEE SMITH CRNA

Provider Business Mailing Address
First Line	:	32072 BORDMAN RD
Second Line	:
City	:	RICHMOND
State	:	MI
Zip	:	48062-2329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	32072 BORDMAN RD
Second Line	:
City	:	RICHMOND
State	:	MI
Zip	:	48062-2329
Country	:	US
Telephone Number	:	810-623-3927
Fax Number	:

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

Provider Enumeration Date	:	07/10/2021
Last Update Date	:	09/13/2021

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