Provider Demographics
NPI:1407616253
Name:SMITH, TYNE
Entity Type:Individual
Prefix:
First Name:TYNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 S LINDEN RD # 257
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5462
Mailing Address - Country:US
Mailing Address - Phone:810-210-4839
Mailing Address - Fax:
Practice Address - Street 1:2503 S LINDEN RD # 257
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5462
Practice Address - Country:US
Practice Address - Phone:810-210-4839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care