Provider Demographics
NPI:1184207276
Name:SMITH, MADDISON K (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MADDISON
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 GOLFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-7649
Mailing Address - Country:US
Mailing Address - Phone:810-358-7371
Mailing Address - Fax:
Practice Address - Street 1:432 GOLFSIDE DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-7649
Practice Address - Country:US
Practice Address - Phone:810-358-7371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704326587NSA21098363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care