Provider Demographics
NPI:1023402419
Name:SMET, KATIE (RN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SMET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3619
Mailing Address - Country:US
Mailing Address - Phone:920-371-1549
Mailing Address - Fax:
Practice Address - Street 1:809 JAMES ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3619
Practice Address - Country:US
Practice Address - Phone:920-371-1549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI219563163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health