MEDICARE: TYRELL 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	163W00000X	Registered Nurse	RN2341753	MA

General Provider Information

NPI Number	:	1699438473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRELL SMITH RN

Provider Business Mailing Address
First Line	:	1029 NORTH ROAD PMB 125
Second Line	:
City	:	WESTFIELD
State	:	MA
Zip	:	01085-9711
Country	:	US
Telephone Number	:	858-346-7096
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 NORTH ROAD PMB 125
Second Line	:
City	:	WESTFIELD
State	:	MA
Zip	:	01085-9711
Country	:	US
Telephone Number	:	858-346-7096
Fax Number	:

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

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	06/09/2023

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