Individual
SUSAN A. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
8224 PARK LN STE 130, VICKERY HEALTH CENTER, DALLAS, TX 75231-6021
(214) 266-0266
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
522587
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100483003
—
TX
05
—
100483004
—
TX
05
—
100483005
—
TX
05
—
100483006
—
TX
05
—
100483007
—
TX
01
—
8Y9217
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/28/2006
Last updated
08/27/2009
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