Individual
ELAINE M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
301 BAY PARK SQ, GREEN BAY, WI 54304-5104
(920) 592-9475
Mailing address
301 BAY PARK SQ, GREEN BAY, WI 54304-5104
(920) 592-9475
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1317
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1317-023
LICENSE
WI
05
—
39842400
—
WI
Enumeration date
05/10/2006
Last updated
07/08/2007
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