MEDICARE: MRS. HEATHER NICOLE SMITH BS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1841787405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER NICOLE SMITH BS

Provider Business Mailing Address
First Line	:	3650 SOUTH POINTE CIR STE 109
Second Line	:
City	:	LAUGHLIN
State	:	NV
Zip	:	89029-0422
Country	:	US
Telephone Number	:	702-299-2017
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 SOUTH POINTE CIR STE 109
Second Line	:
City	:	LAUGHLIN
State	:	NV
Zip	:	89029-0422
Country	:	US
Telephone Number	:	702-299-2017
Fax Number	:

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

Provider Enumeration Date	:	04/19/2018
Last Update Date	:	04/19/2018

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