MEDICARE: MRS. CATHERINE IRENE SMITH NBC-HWC

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	174H00000X	Health Educator	A3138594	CT
2	171400000X	Health & Wellness Coach	A3138594	CT

General Provider Information

NPI Number	:	1790360006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE IRENE SMITH NBC-HWC

Provider Business Mailing Address
First Line	:	9901 BRODIE LN STE 160
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5892
Country	:	US
Telephone Number	:	860-384-3627
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 BRODIE LN STE 160
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5892
Country	:	US
Telephone Number	:	860-384-3627
Fax Number	:

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

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	02/23/2022

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