Provider Demographics
NPI:1518067024
Name:SMITH, MICHELE E (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 REID AVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4440
Mailing Address - Country:US
Mailing Address - Phone:304-327-7921
Mailing Address - Fax:
Practice Address - Street 1:405 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740
Practice Address - Country:US
Practice Address - Phone:304-425-7243
Practice Address - Fax:304-487-3525
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV42053367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00297643OtherRAILROAD MEDICARE
WV8236031Medicare PIN