Individual
MRS. AMY MARY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1615 GRANGE AVE, RACINE, WI 53405-3539
(262) 939-1356
Mailing address
1615 GRANGE AVE, RACINE, WI 53405-3539
(262) 939-1356
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
305029-031
WI
Other
Enumeration date
09/07/2010
Last updated
09/07/2010
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