MEDICARE: BARBARA SMITH LPN

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	164W00000X	Licensed Practical Nurse	305070-031	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	:	1487866430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA SMITH LPN

Provider Business Mailing Address
First Line	:	PO BOX 16235
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-0235
Country	:	US
Telephone Number	:	414-339-9571
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 S 17TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3722
Country	:	US
Telephone Number	:	414-339-9571
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	12/29/2008

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Directions to “ BARBARA SMITH LPN” Practice Location

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