MEDICARE: MARSHA SMITH

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	4703110633	MI

General Provider Information

NPI Number	:	1801247440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA SMITH

Provider Business Mailing Address
First Line	:	14707 WINTHROP ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-4104
Country	:	US
Telephone Number	:	440-506-0360
Fax Number	:

Provider Business Practice Location Address
First Line	:	14707 WINTHROP ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-4104
Country	:	US
Telephone Number	:	440-506-0360
Fax Number	:

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

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	06/24/2016

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Directions to “ MARSHA SMITH ” Practice Location

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