Provider Demographics
NPI:1407817968
Name:SMITH, MISCHERYL ANTOINETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MISCHERYL
Middle Name:ANTOINETTE
Last Name:SMITH
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 1:7707 W GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1060
Mailing Address - Country:US
Mailing Address - Phone:414-355-9903
Mailing Address - Fax:
Practice Address - Street 1:7707 W GLENBROOK RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-1060
Practice Address - Country:US
Practice Address - Phone:414-355-9903
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39985100OtherPROVIDER NUMBER