Provider Demographics
NPI:1679917322
Name:SMITH, ARLANDA LATRICE (MSN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:ARLANDA
Middle Name:LATRICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 W KING ST STE LL
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2116
Mailing Address - Country:US
Mailing Address - Phone:989-729-4292
Mailing Address - Fax:989-725-9012
Practice Address - Street 1:818 W KING ST STE LL
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2116
Practice Address - Country:US
Practice Address - Phone:989-729-4292
Practice Address - Fax:989-725-9012
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224410363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679917322Medicaid