Provider Demographics
NPI:1487900114
Name:SMITH, EDWIN MICHAEL (RN)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 E EXCHANGE RD
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:MI
Mailing Address - Zip Code:48414-9730
Mailing Address - Country:US
Mailing Address - Phone:989-277-6389
Mailing Address - Fax:
Practice Address - Street 1:4940 E EXCHANGE RD
Practice Address - Street 2:
Practice Address - City:BANCROFT
Practice Address - State:MI
Practice Address - Zip Code:48414-9730
Practice Address - Country:US
Practice Address - Phone:989-277-6389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470428766163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse