Individual
MARY BONNIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.P.N.P.
Contact information
Practice address
3643 W FRONT ST, SUITE C, TRAVERSE CITY, MI 49684-7759
(231) 935-0614
(231) 935-0832
Mailing address
3643 W FRONT ST, SUITE C, TRAVERSE CITY, MI 49684-7759
(231) 935-0614
(231) 935-0832
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704077230
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704077230
REGISTERED NURSE LICENSE
MI
Enumeration date
05/04/2007
Last updated
07/08/2007
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