Provider Demographics
NPI:1487050407
Name:SMITH, JULIA LAVETTE (RN BS BSN CHPN)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:LAVETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN BS BSN CHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1134
Mailing Address - Country:US
Mailing Address - Phone:248-804-2457
Mailing Address - Fax:
Practice Address - Street 1:1121 ATKINSON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1521
Practice Address - Country:US
Practice Address - Phone:248-804-2457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704249595163WH0200X, 163WH1000X
372500000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide