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NPI Code Detail

MEDICARE: MRS. CARRAH LEE SMITH-JOHNSON

MEDICARE: MRS. CARRAH LEE SMITH-JOHNSON
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
1164W00000XLicensed Practical Nurse4703116022MI

General Provider Information

NPI Number : 1851922561
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARRAH LEE SMITH-JOHNSON
Provider Business Mailing Address
First Line : 6821 MEDBURY ST
Second Line :
City : DETROIT
State : MI
Zip : 48211-3317
Country : US
Telephone Number : 313-922-2222
Fax Number :
Provider Business Practice Location Address
First Line : 6821 MEDBURY ST
Second Line :
City : DETROIT
State : MI
Zip : 48211-3317
Country : US
Telephone Number : 313-922-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2020
Last Update Date : 09/12/2022

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Directions to “ MRS. CARRAH LEE SMITH-JOHNSON ” Practice Location

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