Individual
SHELLY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
912 PETOSKEY ST, PETOSKEY, MI 49770-2937
(231) 881-0266
Mailing address
912 PETOSKEY ST, PETOSKEY, MI 49770-2937
(231) 881-0266
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703111792
MI
Other
Enumeration date
04/28/2016
Last updated
04/28/2016
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