Individual
MRS. ANNA CORNELIA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, LMT, CN,
Contact information
Practice address
51803 TALL PINES DR, ELKHART, IN 46514
(574) 361-2847
Mailing address
51803 TALL PINES DR, ELKHART, IN 46514-5971
(574) 361-2847
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
NU00001939
WA
225700000X
Massage Therapist
7501010943
MI
225700000X
Massage Therapist
Primary
MT21706344
IN
Other
Enumeration date
04/17/2018
Last updated
05/13/2018
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