MEDICARE: MARLA JANE SMITH RN

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	163WH0200X	Home Health Registered Nurse		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467414656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLA JANE SMITH RN

Provider Business Mailing Address
First Line	:	1241 MEADOWLARK DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53716-1459
Country	:	US
Telephone Number	:	608-222-9611
Fax Number	:

Provider Business Practice Location Address
First Line	:	5002 TWIN OAKS DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53714-2734
Country	:	US
Telephone Number	:	608-226-8919
Fax Number	:

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/09/2007

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